ANXIETY DISORDERS

PREPARED BY:
MARY RUTH V. ENRIQUEZ, RN MAN
ANXIETY DISORDERS
The most common psychiatric disorders
Cause an individual to feel frightened, distress, and uneasy without a specific
cause
(The specific stressor(s) may be out of the clients conscious awareness, and
therefore the client attributes uneasy feelings to bad nerves)
DSM IV TR SPECIFIES THE FOLLOWING TYPES OF ANXIETY DISORDERS
1.GENERALIZED ANXIETY DISORDER= GAD
2. PANIC DISORDERS
3.OBSESSIVE COMPULSIVE DISORDER
4. PHOBIC DISORDER
5. POST TRAUMATIC STRESS DISORDER (PTSD)
Generalized Anxiety Disorder (GAD)
Anxiety (also referred to as excessive worry or severe stress) itself is expressed
symptom.
Worries excessively and feels highly anxious at least 50% of the time for 6 months
and more.
The person has three or more of the following symptoms: uneasiness, irritability,
muscle tension, fatigue, difficulty in thinking, and sleep alterations.
Symptoms may include also:
Muscle aches
Shakes
Palpitation
Dry mouth
Nausea
Vomiting
Hot flashes
Chills
Polyuria
Difficulty swallowing
PANIC DISORDER
Is a state of extreme fear that cannot be controlled.
It is also referred to as Panic Attack, and people may not consider it to be a serious
disorder.

Panic disorder may occur with or without Agoraphobia ( irrational fear of being in open
places/ spaces)
Panic disorder w/out Agoraphobia:
characterized by recurrent, unexpected panic attacks followed by at least 1 month of
persistent concern about having another attack,
Worry about possible implications or consequences of the attack, or a significant
behavioral change related to the attack
Ex . The person becomes homebound.
Panic disorder with Agoraphobia
Is defined as recurrent, unexpected panic attacks along with agoraphobia.
Ex. A person who fear shopping in large mall
The behavior patterns of people with agoraphobia clearly demonstrate the concepts
of:
Primary gain: is the relief of anxiety achieved by performing the specific anxiety- driven
behavior such as staying in the house to avoid the anxiety of leaving a safe place.
Secondary gain: is the attention received from others as a result of these behaviors.
Ex. The person w/ agoraphobia may receive attention and caring concern from family
members, who also assume the responsibilities of family life outside the home. (e.g .
Working , shopping
Panic Disorder
Panic episodes present quickly.
DSM-IV-TR criteria for Panic disorder require at least 4 of a 12 possible symptoms.
Some the behavior may be observed in Panic disorder include:
Fear (usually of dying, losing control of oneself, or of going crazy)
Dissociation (a feeling that it is happening to someone else or not happening at all)
Nausea
Diaphoresis
Chest pain
Increase pulse
Shaking
unsteadiness
PHOBIC DISORDER/ PHOBIA
The most common anxiety disorders.
Defined as irrational fear.
The person is very aware of the fear and even of the fact that it is irrational, but the
fear continues.
People develop phobias to many different things.
Ex. Snakes, spiders, enclosed spaces.

People also develop phobias of things such as caring for their children (because they
might hurt them) and eating in other places other their own home.
The Psychoanalytic view implies
That the fear is not from the object itself necessarily but rather a fear of the defense
mechanism displacement.
Ex. The person w/ a phobia of snakes may have seen a frightening movie in w/c someone died
from a snake bite. This persons fear of snakes, then, may result not from the snake itself, but
from fear of dying from venom of a bite.
The stated object of the phobia would be interpreted as a symbol for the underlying
cause of the fear.
Phobias 3 subcategories:
Agoraphobia
Social phobia
Simple phobia
AGORAPHOBIA = IS IRRATIONAL FEAR OF BEING IN AN OPEN SPACES.
SOCIAL PHOBIA = are those in w/c people avoid social situations as a result of fear of
humiliation.
Ex. Fear of speaking in public and fear of using public facilities such as bathroom
SIMPLE PHOBIA: is having an irrational fear of a specific object or situation, and these
are the ones we hear most about.
Ex. Claustrophobia (fear of close spaces), and Acrophobia ( fear of heights)
OBSESSIVE- COMPULSIVE DISORDER (OCD)
This type of anxiety disorder consist of two parts:
The Obsession = repetitive thought, urge, or emotion
The Compulsion = repetitive act that may appear purposeful
Ex. Of OCD: is the need to check numerous times that doors are locked before one is
able to sleep or leave the house.
In reality, this need to repetitively check the locks may prevent the person from
sleeping or leaving at all.
The person w/ this kind of anxiety disorder is unable to stop the thought or the
action.
Behavior become very ritualistic. It is thought or the action that reduces the anxiety.
Defense mechanism associated as possible contributors to OCD : REPRESSION,
REACTION FORMATION, & UNDOING.
OCD
A Genetic link among families who display OCD
In 1987, the APA released a study saying that
OCD is more common among first-degree biologic relatives of persons w/ this
disorder than among the general population.
Behaviors in patients w/ OCD vary

Some people wash their hands unceasingly

Others have strict ritual that, if interrupted, requires starting over from the beginning
Some people have to check something or clean something over and over. People w/
this disorder tend to be perfectionistic and very rule-oriented.
POST TRAUMATIC STRESS DISORDER (PTSD)
This disorder is developed in response to an unexpected emotional or physical trauma
that could not be controlled.
DSM-IV-TR includes words Actual or Threatened in describing the traumatic events that
may trigger PTSD.
Ex. People who have fought in wars, have been raped, have survived violent storms
or violent acts.
PTSD
Symptoms may appear immediately or be repressed until years later
DSM-IV-TR requires that symptoms be present for at least 1 month.

flashbacks, in w/c the person may relive and act out the traumatic event

Social withdrawal

Feelings of low self-esteem as a result of the event

Changes in relationship w/ significant other and difficulty forming new

relationships

Irritability and outbursts of anger toward another person or situation, seemingly

for no obvious reason

Depression

Chemical dependency, as a physical or behavioral response to the traumatic

experience

MEDICAL TREATMENT FOR ANTIANXIETY DISORDERS:

ANTIANXIETY DRUGS: MOST COMMON, BENZODIAZEPINES, use in short term

because of the strong potential for dependency.

Antidepressant and antipsychotics are effective to some people. If these

medications are not effective in treating symptoms , Monoamine oxidase
inhibitors or Lithium carbonate may be prescribed.

SSRI, specifically Luvox (fluvoxamine), medication of choice for Obsessive Compulsive

disorder.

Psychotherapy :includes individual treatment, group therapy, and systematic

desentization techniques to help the patient experience the anxiety-producing situation
in a controlled environment and integrate the painful feelings associated with the anxiety.

Alternative Interventions for Anxiety disorders

Aromatherapy : essential oils as peppermint or eucalyptus are popular aids in relaxation.
Biofeedback : is a form of behavior modification. It is a system of progressive relaxation. There
are many tapes and products on the market to assist patients in this do it-yourself method of
relaxation.

Hypnosis : done by qualified, licensed therapist. Patient will have to continue to take time to do
the relaxation as directed by the therapist.
Nursing Intervention for Anxiety disorders:
1. Maintain a calm milieu: patient who have anxiety disorders need to have their
treatment area calm and safe.
2. Maintain open communication: encourage verbalize all thoughts and feelings. Honesty
in dealing w/ patients helps them learn to trust others and increases self-esteem.
3. Observe for signs of suicidal thoughts: especially those suffering w/ PTSD, are at risk
for suicide as a result of feeling low self-esteem or decreased self-worth.
4. Document any changes in behavior: any change, no matter how small, can be significant
to the patients care.
5. Encourage activities: activities that are enjoyable and non-stressful help the patient in
several ways.
SOMATOFORM DISORDERS
Are conditions in w/c there are physical symptoms with no known organic cause.
It is believed that the physical symptoms are connected to a psychological conflict.
SOMATOFORM DISORDERS
5 types
SOMATIZATION DISORDER
CONVERSION DISORDER
HYPOCHONDRIASIS DISORDER
PAIN DISORDER
BODY DYSMORPHIC DISORDER
SOMATIZATION DISORDER
Onset of symptoms is usually observed at approximately age 30.
Is characterized by multiple physical symptoms.
Includes a combination of pain and gastrointestinal, sexual, and pseudoneurologic
symptoms.
Some of the frequently seen symptoms:
Free-floating
Emotional turmoil express in physical symptoms, resulting in loss of physical
functioning
Pain that changes location frequently
Depression
Suicidal ideation
CONVERTION DISORDER
Sometimes called conversion reaction
Involves unexplainable, usually sudden deficits in sensory or motor function

Ex. Blindness and paralysis

These deficits suggest a neurologic disorder but are associated with psychological factors.
An attitude of la belle indifference, a seeming lack of concern or distress, is the key feature.
Even though the patient is concerned enough about the symptoms to consult the physician, he
gives the impression of really not caring about the problem
HYPOCHONDRIASIS
Is preoccupation with the fear that one has a serious disease (disease conviction) or
will get a serious disease (disease phobia).
It is though that clients with this disorder misinterpret bodily sensations or functions.
PAIN DISORDER
Has primary physical symptoms of pain, w/c generally is unrelieved by analgesics and
greatly affected by psychological factors in term of onset, severity, exacerbation, and
maintenance.
BODY DYSMORPHIC DISORDER
Is preoccupation w/ an imagined or exaggerated defect in physical appearance such
as thinking ones nose is too large or teeth are crooked and unattractive.
The onset is generally in the teens through the 30s.
Somatization disorder
Conversion disorder more common in women
Pain disorder
Medical Treatment for Somatoform Disorders
Hospitalized patients are usually admitted to a medical unit rather than a psychiatric
unit.
Treatment focuses on the symptoms, w/c more than likely are medical in nature.
Medications : Selective Serotonin Reuptake Inhibitors (SSRIs) (Fluoxetine)
Antidepressants : Tricyclic such as Imipramine
Antianxiety
Alternative Treatments
Massage therapies: are believe not only relieve tensions and discomforts in the musculoskeletal
system, but also may assist with blood and lymph flow.
Alternative Treatment
Herbal / Nutritional Supplements: it is possible that a patient is experiencing a
nutritional deficiency or possibly a condition such as arthritis along w/ the
somatoform disorder.
Herbs or supplements geared to the specific pain issue may help the patient to
experience less pain, either physically or psychologically.
Nursing Management
Communication skills:
Honesty in dealing w/ the patient is very important.

 Gaining trust that encourage the patient to verbalize thoughts and feelings about
physical and emotional aspects of this type is crucial.
Do not discount the patients disorder.
Ex. Nurse: Ms. P, your physician can find no physical or life-threatening
conditions at this time. we will make every attempt to help you improve.
Therapy :
Keeping the patient focused on other topics may help in the recovery.
Nurses will involve the patient in the goal setting and intervention of the care
plan.
Aiding the patient in learning assertive communication skills can be helpful.
Working w/ other staff in occupational therapy, recreational therapy, and social
activities can also act as diversion to focus away from the dysfunction.
Support :
It is important for the nurse caring for the patients w/ somatoform disorders to
remember to pay attention to the person but not to reinforce the symptom.
Always make a thorough head-to toe assessment.
This shows patients you are concerned for their health but you will not be
focusing on the area of dysfunction or reinforcing the problem.
Document all findings in a matter-of-fact way. Patients need to know that they
may not agree w/ the medical findings of their illness.
Summary
Dissociative Disorders
Dissociation : a subconscious defense mechanism that helps a person protect his/her
emotional self from recognizing the full effects of some horrific or traumatic event by
allowing the mind to forget or remove itself from the painful situation or memory.
To separate a strong emotional response from the consciousness.
4 TYPES OF DISSOCIATIVE DISORDERS
1. PSYCHOGENIC AMNESIA
2. PSYCHOGENIC FUGUE
3. DEPERSONALIZATION DISORDER
4. MULTIPLE PERSONALITY DISORDER OR DISSOCIATIVE IDENTITY DISORDER
DISSOCIATIVE DISORDERS
PSYCHOGENIC AMNESIA
Is a sudden inability to recall personal information as a result of some physical or
psychological trauma.
It is not organic
It goes beyond ordinary forgetfulness and is not the kind of memory dysfunction
found in dementia.
It is seen more frequently in adolescents and young women.

Symptoms: wandering, confusion, and disorientation

The condition is usually temporary.
Psychogenic Fugue
Is even more dramatic in its symptoms than psychogenic amnesia.
People who have psychogenic fugue often suddenly leave town and take on a new
identity, which fools people for a short time.
The person does not appear to be confused or disoriented.
It takes time before the stories get mixed up or do not flow well together. this usually
tips off someone that the person is not quite right
Psychogenic Fugue
is also usually short lived.
It last a few hours to a few days.
Usually follows some sort of severe stress and is often triggered by alcohol use.
Once recovered it is rare for this condition to recur.
DEPERSONALIZATION DISORDER
Usually affects people under age 40.
Person remains oriented to person, place, and time, but perception of reality
has changed.
The patient w/ this disorder can talk about it somewhat, often describing the
feeling that he or she is Floating or out of my body.
The patient may express the fear of going crazy.
It is quite possible that the person will attempt suicide.
Can coincide w/ others disorders such as schizophrenia, personality disorders,
and seizure disorders.
MULTIPLE PERSONALITY DISORDER OR DISSOCIATIVE IDENTITY DISORDER
Two or more completely separate personalities exist w/in one body.
No matter how many personalities are living within one body, the main, or primary
personality is the one that is forward most of the time.
alters, is the other personality
Ex. Imagine that your best friend, Pat, is a kind, gentle ,loving person. that is the
personality Forward most of the time and the person you work with and share
with. All of a sudden, you and Pat are at the mall and Pats personality changes. Pat
has a different voice and a different walking gait. You say, Pat, are you all right?
and, to your amazement, Pat says, Im not Pat! Pats a bore. Im Chris and Im a lot
more fun! Lets blow this place! Chris is also the opposite gender of Pat.
Multiple Personality
Medical Treatment
Medication: usually antianxiety
Sedatives , Mood elevators , and antidepressants are also effective for some patients.

Psychotherapy is used individually and possibly in groups.

Hypnotherapy , a hypnotherapist in many instances can help the patient explore those other
sides of the self that are painful and repressed.
Alternative Treatment
Depending on the persons emotional state, methods that stabilize into reality are
most appropriate.
Independent alternative treatment could include biofeedback and aromatherapy
Nursing Interventions
1. Focus on short-term goals: it is believe that several small successes will help to
integrate the personality into a better, overall healthier state
2. Maintain a calm milieu: reducing anxiety is a major goal in treating these types of
illnesses.
3. Keep communication open: encourage the patient to verbalize thoughts, feelings, and
concerns. If you are working with a patient who has MPD, address the ALTER by his or her
name, not by the name of the primary personality, unless advised to do so by the
physician. Document very carefully the interaction with the ALTER and activities that
directly preceded and followed the presence of that personality.
4. Observe for signs of suicidal thought: this will be especially appropriate for patients with
depersonalization disorder and MPD. The feeling of being crazy "or the personality of any of
the alters can result in suicidal thoughts.
5. Document any changes in behavior: never assume that what you observe in a patient is
significant. Document any and all changes that you perceive in the patients behaviors and
attitudes.