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Running Head: ANXIETY DISORDERS

Anxiety Disorders

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Introduction

When faced with a problem or threatening situation, every normal human being

experiences anxiety. It is an unpleasant state of mind, causing nervous behavior, such as pacing

back and forth, lack of attention and feeling of uneasiness. For a normal person, anxiety vanishes

after the triggering factor is removed. Anxiety may be appropriate in certain situations, but

excessive and enduring anxiety becomes a psychological disorder. Anxiety disorders are

different, because it causes chronic distress and disrupts normal life even after the anxiety

causing element is gone (Yates, 2012). American Psychiatric Association (2013) depicts anxiety

disorder as a serious mental illness, and states that it is not fear. Fear is a response to a real or

perceived danger, while anxiety is the anticipation of imminent threat. Anxiety causes muscular

tension, fatigue, perspiration, restlessness, and problems in attention in the victim. American

Psychiatric Association (2013) classifies several types of anxiety disorders such as panic
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disorder, social anxiety disorder, specific phobias, generalized anxiety disorder, etc. Five types of

anxiety disorders will be discussed in this essay.

Generalized anxiety Disorder (GAD)

Generalized anxiety disorder (GAD) is the most common disorder which is classified as

anxiety disorder having chronic, excessive worrying and anxiety about everyday life (Gliatto M

F, 2000). The feeling of apprehension is so severe that it hampers the ability to carry on life, and

the victim cannot control the worry. Individuals with GAD have both physical and psychological

symptoms of anxiety, and symptoms develop slowly. Physical symptoms include, dry mouth,

nausea, urinary frequency and sweating; emotional cues of GAD are irritability, fearfulness,

sadness and suspiciousness, and behavioral cues are forgetfulness, pacing / fidgeting, decreased

concentration and social withdrawal (Gliatto M F, 2000). Somatic symptoms of GAD includes

headache, body aches, heaviness in chest, constipation, shortness of breath and muscle tension

(Jaffe, S., & Schub, T. 2014).

Causes of GAD are not clear, but the neurochemical basis of this disorder suggests

abnormal serotonergic and noradrenergic neurotransmission. Other possible causes of GAD are

genetics, environmental, developmental, and psychological factors. There are many therapies

applied for GAD. However, treatment depends on various factors contributing to the symptoms

and the goal of the intervention. GAD is managed by cognitive behavioral therapy, behavioral

therapy, bio-feedback, support groups, and medication (Benzodiazepines to relax the body,

anti-anxiety drugs, and antidepressants).

The case of Sheela will illustrate the nature of symptoms of GAD. Sheela is a 28-year-old

finance analyst graduated with good marks and high grades. Sheela has been an anxious person,
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and she humorously calls herself a "worry bug." During her high school, it was difficult to

control her worry, which costed her grades, friends, and parents She had fears one after other,

first it was grades, and then graduate school, boyfriends, her pet cats, work performance, health,

income, etc. everything was worrying her. Sheela had great difficulty in controlling the worries.

She felt exhausted most of the time with muscle tension and body aches. Sheela can't remember

when she was relaxed last time. For the past six months she hasn't been sleeping very well. She

often lies in bed worrying for several hours, frequently wakes during the nights, or wakes up too

early and can't fallback asleep. During day time, she had difficulty concentrating at work. Sheela

checks her work excessively and often she is late in completing the work. Sheela knows she has

a psychological problem but does not take steps to meet the mental health professional.

GAD is regarded as the most common anxiety disorder. The highest occurrence of GAD

is found in persons between 45 to 49 years of age (7.7 percent), and the lowest in persons who

are 60 years and older (3.6 percent). Women are prone to GAD than men, and the prevalence of

GAD decreases with age in men, but increases for women (Kavan M G, Elsasser G N., and

Barone E J., 2009).

Panic Disorder

Panic attacks are a composite part of panic disorder. Panic attacks are a distinct period of

intense fear or distress, in which symptoms such as palpitation, sweating, trembling, chest pain

dizziness, fear of dying, fear of going crazy, chills, hot flashes or nausea, develop abruptly and

reach a peak within 10 minutes (American Psychiatric Association (2013). Panic disorder is an

anxiety disorder having panic attacks on a regular basis (Bouton, Mineka, & Barlow. 2001).

People with panic disorders worry continually about having another attack or attacks. Worry

accompanied by some noteworthy change in behavior, such as avoiding certain place, people or
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things are a key indicator of panic disorder. The symptoms of worry and fear triggered by a

thought or presence of certain things or even words must persist for at least one month to be

classified as panic disorder (American Psychiatric Association (2013). If the panic attacks are

correlated with specific stressors, the victim cannot be diagnosed as having panic disorder.

Another major symptom associated with panic disorder is agoraphobia, and this phobia is so

severe that sufferers will not leave the house as an attempt to avoid a panic attack (Bouton,

Mineka, & Barlow. 2001)

Researchers have attributed three causes that predispose a person to panic disorder. One

is the biological and genetic basis; second is the leering in response to stressful situations, and

finally, a perspective proposes that initial panic attacks are the body's natural reaction in the form

of fear occurring at an inapt time. Following this initial attack a small percentage of individuals

somehow develop an anxiety about future attacks (Barlow, H, & Durand, M, 2005). Treatment of

panic disorder can be classified into three main categories; pharmacological, psychological and

combination of these two approaches (Barlow, H, & Durand, M, 2005). Pharmacological therapy

focuses on the use of either benzodiazepines or anti-depressants, to control and alleviate the

body's reaction to internally triggered panic cues (Beamish, P. M., Granello, D. H. & Betcastro,

A. L. 2002). The major psychological approach to panic disorders is cognitive behavior therapy

(CBT), and the combined approach utilizes the strengths of medication and CBT. Panic disorder

is affecting three to six million Americans every year (Beamish et al., 2002).

Panic attacks of Clara, who is 34 years of age, single woman, living alone and working

for a local telephone company are characterized by the following symptoms. She had her first-

panic attack two years ago, along with agoraphobia. The first attack was when she was driving

on a bridge, and it was raining outside. In the first attack, she experienced pounding of heart,
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dizziness, choking of breath, trembling and muscular tension. After that incident she had

experienced panic attacks at least ten times, during which she felt loss of control. As a result of

frequent panic attacks, she expects it can happen anytime and avoids socializing, movies,

elevators, driving over bridges, rainy days, etc. She is even avoiding activities such as playing

tennis, shopping, etc.

Phobia

A phobia is an unrealistic and intense fear which interferes with day to day activities, the

socialization process, work performance, etc. of a person. American Psychiatric Association

defines phobia as an irrational and excessive fear of an object or situation. All phobias can be

categorized into three i.e. social phobia, agoraphobia, and specific phobia. The symptoms of

phobias include feeling of panic, fear without actual threat or danger, reactions are automatic and

uncontrollable, rapid heartbeat, strong desire to flee the situation or avoid the triggering object,

trembling, excessive sweating, muscular twitches, etc.

The exact causes of phobias are not known. Probable causes are genetic factors,

neurochemistry of the brain and emotional trauma in prior social situations. Many psychologists

believe the cause phobia is not singular but a combination of genetic factors along with

environmental and social factors (Hall). Psychologists consider Phobia as the result of classical

conditioning or vicarious learning. Avoidance behavior sustains fear, and it prevents the victim to

challenge the phobia symptoms such as personal anxiety, physiological arousal, etc. and

therefore fear is not resolved but reinforced negatively. Therefore, extinction of fear is what

required (Emmelkamp et al., 2002). Cognitive Behavior therapy is the most widely used

treatment along with administration of anti-anxiety drugs and antidepressants.

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In the US, about 4.4% percent of the adults have one or more phobias, and they persist

for years before symptoms become chronic (Narrow et al., 2002). Social phobia is the most

common type of phobia and the 3rd most common psychiatric disorder (Craske, 1999). The

following description of a person with an abnormal fear depicts social phobia. Philip is a

handsome man in thirties. He was shy from his boyhood days and had social anxiety from

teenage years. He had married a girl (Lily) whom he knew very well and has three children, two

boys and a girl. Now, Philip is very shy and averts his eyes from people when he meets them.

However, he somehow shake hands, responds to questions, and smile a genuine smile. Philip

confesses that he suffered anxiety from childhood, and he was backward in school. After

marriage, his wife took charge of all day today jobs relieved him of domestic responsibilities,

which worsened his situation. Because of the wife, Philip avoided all social responsibility. He

worked in music store where customers walked in and interacted with the sales person and

sometimes Philip has to interact with the customers because he was in charge of ordering the

stock. Philip had difficulty in maintaining eye contact with the strangers and did not conduct the

conversations in a professional way. This behavior affected the business and Lily came to know

about this and decided to seek professional help.

Obsessive- Compulsive Disorder (OCD)

Obsessive-compulsive disorder is a difficult to recognize as a disorder, and is often

undertreated. The illness can cause marked distress and disability to its victim. American

Psychiatric Association (2013) defines OCD as a chronic and relapsing anxiety disorder having

persistent thoughts and compulsive actions that can damage sufferers daily functioning. The

repetitive actions can be mental or physical. Even though the patient is aware of the obsessive
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thoughts and actions, he/she feels helpless in controlling it. Symptoms manifests at mental and

physical level. Obsessions occur at thought level and are experienced as repetitive and intrusive

ideas, impulses, or images. Patients of OCD have reported persistent fears, an unreasonable

concern for contamination and safety, unacceptable religious thoughts, excessive attempt to do

things perfectly, etc. Compulsions happen at action level. Some of the behaviors seen in

individuals with OCD are, repeated checking of door locks and light switches, counting

something repeatedly, making lists, arranging or aligning things, gathering and hoarding useless

things, unnecessary rereading and rewriting, mentally repeating words, phrases, and sentences

(not in meditative intent ), washing hand many times, etc.

Complete understanding about the causes of OCD is lacking. OCD is considered as

occurring due to neurobiological, genetic, environmental and psychological effects. However,

scientists have found an imbalance of a brain chemical called serotonin as the neurochemical

cause of OCD (Simpson HB, Foa EB, Liebowitz MR, et al. 2008). Anatomical peculiarity of

orbitofrontal cortex and dynamics of dopamine also seem to be influencing OCD. Treatment of

OCD depends on particular needs and conditions of the victim. Common psychological therapies

are exposure and response prevention, aversion therapy, thought switching, flooding, implosion,

and thought stopping. Selective medication is recommended with serotonin reuptake inhibitors

(SSRIs) to reduce OCD symptoms and tricyclic antidepressants for other concurrent symptoms.

Sarvet (2013) reports that one to three percent of children and adults have OCD, and its

occurrence is equal to both sexes. 80 percent of the time, symptoms of OCD manifests before the

age of 18. A study by the World Health Organization in the year 2000 found differences in the

incidence of OCD around the world. Latin America, Europe and Africa have incidences of OCD

two or three times more than in Asia. Kathys case vividly describes a typical OCD indicator. She
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is Jewish female with an age of 40 years, a divorcee, and employed as an accountant in a large

book store. She speaks to her friends, relatives and even strangers about how she feels about

getting a vaginal yeast infection, and she believed this would ruin her health. She speaks at

length about genital hygiene and physiology associated with it. She has the insight that she is

excessively talking about this topic, but could not control talking about it. Recently, she

confessed that she is very promiscuous these days, and occasionally she uses this as the topic of

her non-stop chatter.

Post-Traumatic Stress Syndrome

Post-traumatic stress disorder (PTSD) is an anxiety disorder that occurs following an

experience of a traumatic event. Grinage, Bradley D. (2003) reports that PTSD condition often

goes undiagnosed. PTSD symptoms include persistent re-experiencing of the event, flashbacks,

hallucinations, delusions and illusions about the traumatic event, avoidance of event-related

objects and people, frequent mood variations and impairment in cognitive abilities, and thoughts

of suicide. Pathophysiology of PTSD is not completely known, but some anatomical and

physiological mechanisms have indicated that frequent activation of the amygdala, loss of

volume of the hippocampus, and disruption of the hypothalamic-pituitary-adrenal (HPA) axis in

PTSD patients. Early diagnosis, right treatment and family support can help the victim to

recuperate faster. Immediate intervention recommended for PTSD is pharmacotherapy or

medication. As the condition of the patient improves, Cognitive behavioral therapy (CBT),

family counseling, and group therapy shall help in reducing the manifestations of PTSD.

A study by Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB (1995) reports that

approximately thirty percent of victims of traumatic events develop symptoms of PTSD;

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however, prognosis varies depending on the severity of the trauma. Jacks case indicates the

gravity of post-traumatic stress. Jack was 54 when he witnessed his grandson die in a horrible

automobile accident. Jack is very close to the family and involved in its welfare, but now he is

experiencing flashbacks of the dreadful experience and makes him disconnected with reality. He

is dreading the occurrence of the flashback episodes and somehow attempts to avoid the bad

memories of the accident (e.g., avoiding photographs of his grandson, do not read news column

that involves death, and even find it difficult to face his grandsons friends). Jack began working

for more than 12 hours a day to cope up with the trauma, but he is not able to make productive

contributions to work and makes errors and mistakes more than normal expectations. He is

irritable, gets angry often and uses abusive language to most around him. Recently he began

talking about life worth not living and mentioned about suicide to his wife.

Conclusion

There is a multitude of research studies and information available on the anxiety

disorders. The field is vigorous in research, and many useful findings are reported, and it is

growing. Effective management and therapies are developed for most of the anxiety disorders.

However, the causes and etiology of the disorders are not adequately known. As scientists

carryout the research on anxiety disorders, it is apparent that many disorders are caused by a

blend of factors within and outside the individual. For disseminating the valuable findings of the

behavioral scientists, an initiative to educate the public about anxiety disorders is required. This

step can help in early identification of symptoms in people who are prone to anxiety disorders.

The understanding of the brains function and the contributing factors from the environment,

scientists are likely to invent better approaches to anxiety disorders.

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Yates, W. R. (2012). Anxiety disorders, Medscape reference. Retrieved July 2014,

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Jaffe, S., & Schub, T. (2014). Generalized Anxiety Disorder. Quick lesson. Retrieved July
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