ANXIETY – is used to describe feelings of uncertainty, uneasiness, apprehension

or tension that a person experiences in response to an unknown object or

situation.
• A “fight or flight” decision is made by the person in an attempt to overcome
conflict., stress, trauma or frustration.
FEAR – differs from anxiety because it is the body’s physiologic and emotional
response to a known or recognized danger.
• A person whose car stalls on a railroad crossing experiences fear of injury or
death as the train approaches the crossing.
TYPES OF ANXIETY:
SIGNAL ANXIETY- is a response to an anticipated event.
ANXIETY TRAIT – is a component of personality that has been present over a long
period and is measurable by observing the person’s physiologic, emotional and
cognitive behavior.
- The person who responds to various nonstressful situations with anxiety is
said to have anxiety traits.
ANXIETY STATE – occurs as the result of a stressful situation in which the person
loses control over emotions.
FREE-FLOATING ANXIETY – is anxiety that is always present and accompanied
by a feeling of dread. The person may exhibit ritualistic and avoidance behavior
(phobic behavior).
PHASES OF ANXIETY:
1. NORMAL ANXIETY – is present in a small degree, can motivate people and
is necessary for survival.
2. ACUTE ANXIETY – interferes with one’s ability to think and is referred to as
extreme nervousness. It usually occurs suddenly and lasts a short time.
3. CHRONIC ANXIETY – may be present over a period of months or years. The
person appears to be stable but exhibits tremulous motor activity and rigid
posture.
4. PANIC ANXIETY – is a severe form that causes disintegration of the
personality, resulting in the inability to function normally, but may begin
during childhood.
LEVELS OF ANXIETY:
Level Zero: EUPHORIA
• This is an exaggerated feeling of well-being that is not directly proportionate
to a specific circumstance or situation.
• Euphoria usually precedes the onset of level one: mild anxiety.
• However, many individuals experience episodic euphoria without
transitioning to level one.
Level One: MILD ANXIETY
• This stage can be a positive experience in which a person has an increased
alertness to inner feelings or the environment.
• At this level, an individual has an increased ability to learn, experiences a
motivational force, may become competitive and has the opportunity to be
individualistic.
Level Two: MODERATE ANXIETY
• During this stage, a narrowing of the ability to perceive occurs.
• The person is able to focus or concentrate on only one specific thing.
• Pacing, voice tremors, increase rate of verbalization or talking, physiologic
changes, and verbalization about expected danger occur.
Level Three: SEVERE ANXIETY
• The ability to perceive is further reduced and focus is on small or scattered
details.
• Inappropriate verbalization or the inability to communicate clearly occurs at
this time owing to increased anxiety and decreased intellectual thought
processes.
• Lack of determination or the ability to perform occurs as the person
experiences feelings of purposelessness.
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Level Four: ANXIETY, PANIC STATE
• In this stage, complete disruption of the ability to perceive takes place.
• Disintegration of the personality occurs as the individual becomes
immobilized, experiences difficulty verbalizing, and is unable to focus on
reality.
• Physiologic, emotional and intellectual changes occur as the individual
experiences a loss of control.
COMMON CLINICAL SYMPTOMS OF ANXIETY
Physiologic Symptoms Behavioral Symptoms
Elevated PR, BP and RR Pacing
Dyspnea or hyperventilation Inability to sit still
Diaphoresis Fingering hair continuously or other
Vertigo or lightheadedness nervous habits
Blurred vision Hypervigilance
Anorexia, nausea and vomiting
Frequent urination Intellectual or Cognitive
Symptoms
Headache Decreased interest
Insomnia or sleep disturbance Inability to concentrate
Weakness or muscle tension Nonresponsiveness to external stimuli
Tightness in the chest Decreased productivity
Sweaty palms Preoccupation
Dilated pupils Forgetfulness
Orientation to past rather than
Psychological or Emotional Symptoms present or future
Withdrawal Rumination
Depression
Irritability
Crying
Lack of interest or apathy
Hypercriticism
Anger
Feelings of worthlessness, apprehension
Or helplessness

The following are anxiety disorders as classified according to the Diagnostic and
Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR).
PANIC DISORDER WITH OR WITHOUT AGORAPHOBIA
• Panic disorder is a real illness with both a physical and a psychological
component.
• Typically, an individual’s first panic attack seems to occur “out of the blue”
while the person is engaged in some ordinary activity such as grocery
shopping, driving a car, or doing household work.
• The individual suddenly experiences frightening and uncomfortable
symptoms that may include terror, a sense of unreality or a fear of losing
control.
• Onset usually begins during late teens or early twenties, and although it can
occur in both men and women, most individuals with panic disorders are
women (approximately 75%).
• Panic usually last between 1 minute and 1 hour.
• The intensity of the attacks m ay fluctuate considerably in the same person.
• During panic attack, the individual may experience a fear of being alone in a
public place (agoraphobia).
• After a panic attack, the individual exhibits concern about having additional
panic attacks, worries about implications of the attack or its consequences,
or displays a significant change in behavior.
CLINICAL SYMPTOMS OF PANIC ATTACK
▪ Palpitations ▪ Nausea or abdominal distress
▪ Diaphoresis ▪ Vertigo
▪ Tremors ▪ Feelings of unreality or of being
detached
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▪ Shortness of breath or smothering
sensation
▪ Feeling of choking
▪ Chest pain or discomfort
▪ Chills or hot flashes
from oneself
▪ Fear of losing control or of going crazy
▪ Fear of dying
▪ Numbness or tingling sensations

PHOBIC DISORDERS
• Phobias are the most common form of anxiety disorders.
• Phobia is described as an irrational fear of an object, activity or situation that
is our of proportion to the stimulus and results in avoidance of the identified
object, activity or situation.
• A person unconsciously displaces the original source of fear or anxiety, such
as unpleasant childhood experience, to an external source.
• Avoidance of the object or situation allows the person to remain free of
anxiety.
Agoraphobia
• Agoraphobia is the fear of being alone in public places from which the person
thinks escape would be difficult or help unavailable if he or she were
incapacitated.
• Recognized as the most common phobic disorders.
• Normal activities become restricted and individuals refuse to leave their
homes.
• Common in women and symptoms develop between ages 18 and 35 years.
Social Phobia
• Social phobia is a compelling desire to avoid situations in which others may
criticize a person.
• The person experiences persistent, irrational fear of criticism, humiliation or
embarrassment.
• Examples of social phobias are fears of public speaking, using public
restrooms, or using public transportation.
• The person realizes that the fear is excessive or disproportionate to the
activity or situation.
• Social phobia rarely is incapacitating but may cause considerable
inconvenience.
Specific Phobia
• A specific phobia is defined as an excessive fear of an object, an activity or a
situation that leads a person to avoid the cause of that fear.
• 5 subtypes of this disorder: 1) animal; 2) natural environment; 3) blood-
injection-injury; 4) situational; 5) others (sound, space or costumed
characters)
• The content of phobias as well as their prevalence varied with culture and
ethnicity.
GENERALIZED ANXIETY DISORDER (GAD)
• Generalized anxiety disorder (GAD) is commonly seen in primary care setting
and is associated with disability, medically unexplained symptoms and
overuse of health care resources.
• This disorder is characterized by unrealistic or excessive anxiety and worry
occurring more days than not in a 6-month period.
• The concern is about several events, such as job or school performance, and
the individual is unable to control the worry.
• At least three of the following six symptoms are reported: 1) restlessness; 2)
fatigue; 3) impaired concentration; 4) irritability; 5) muscle tension; and 6)
sleep disturbance.
OBSESSIVE-COMPULSIVE DISORDER
• OCD is characterized by recurrent obsessions or compulsions or a
combination of both that interfere with normal life.
• Obsession is a persistent, painful intrusive thought, emotion or urge that one
is unable to suppress or ignore.
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 • Common obsessive thoughts involve religion, sexuality, violence, the need
for symmetry or exactness and contamination.
• Compulsion is the performance of a repetitious, uncontrollable, but
seemingly purposeful act to prevent some future event or situation.
POST-TRAUMATIC STRESS DISORDER
• The more common antecedents of PSTD include sexual and other assaultive
violence, traumatic losses and war-related trauma (Mellman, 1999).
• Exposure to trauma is more common in some cultural settings.
• The risk for the development of clinical symptoms increases proportionately
with the duration and severity of the trauma such as rape, combat, politically
motivated torture or genocide.
• The diagnosis of acute onset refers to symptoms that last less than 3
months. If more than 3 months, it is chronic.
CLINICAL SYMPTOMS OF POST-TRAUMATIC STRESS DISORDER
• Recurrent and intrusive distressing recollection
• Recurrent distressing dreams
• Acting or feelings as if event were recurring
• Intense psychological distress to internal or external cues symbolizing an aspect of
the event
• Physiologic reactions on exposure to stimuli that resemble an aspect of the event
• Avoidance of thoughts, feelings or conversations associated with trauma
• Avoidance of activities, places or people associated with the trauma
• Inability to recall an important aspect of the trauma
• Feeling of detachment or estrangement from others
• Restricted affect
• Insomnia
• Labile emotion
• Decreased concentration
• Hypervigilance
• Exaggerated startle response
ACUTE STRESS DISORDER
• Acute stress differs from PSTD in symptoms occur during or immediately
after the trauma,
• Lasts for at least 2 days and either resolve within 4 weeks after the
conclusion of the event or the diagnosis is changed to PSTD
• Individual experiences dissociative symptoms such as numbness o
detachment, reduction of awareness in surroundings, derealization or
dissociative amnesia.
• The traumatic event is persistently reexperienced although individuals avoid
the stimuli that arouses recollections of the trauma.
• Marked symptoms of anxiety or increased arousal occur.
• Social and occupational functioning are significantly impaired. The individual
is unable to pursue necessary tasks.
ANXIETY DISORDER DUE TO MEDICAL CONDITION
• Anxiety disorder is due to a general medical condition include prominent
anxiety, panic attacks or obsessions or compulsions that are judged to be
due to the different physiologic effects of a medical condition.

MEDICAL PROBLEMS THAT CAN CAUSE ANXIETY

Cardiovascular: arrhythmia, CHF, ischemic heart failure, MVP, pulmonary
embolism
Endocrine: Addison’s disease, Cushing’s syndrome, hypo &
hyperthyroidism,
Hyperglycemia, hyperparathyroidism, hyperadrenocortisism
Hematologic: anemia, cancer, etc
Neurologic: CVA, encephalopathy, neoplasms, encephalitis
Nutritional: deficiency in Vit. B12, folate and iron
Respiratory: COPD, pneumonia, hyperventilation

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SUBSTANCE INDUCED ANXIETY DISORDER
• Anxiety disorder caused by substances and chemicals.

ATYPICAL ANXIETY DISORDER

• Atypical anxiety disorder is a catchall category for clients who exhibit signs
of an anxiety disorder but do not meet criteria for any of the previously
described conditions