ANXIETY DISORDERS

Definition

Disorders in which the main symptom is excessive or unrealistic anxiety and fearfulness

Anxiety can be a fear of a specific object, or a general emotion, such as unexplained worrying

Free-floating anxiety – anxiety that seems to be unrelated to any realistic, known factor, and is often a symptom of an anxiety disorder.

Types of Anxiety Disorders

PhobiaObsessive-compulsivePanic Generalised Anxiety

DisorderPost Traumatic Stress

Disorder

Prevalence

Around 10% of the population at any given time (AIHW, 1999b)

Women in Australia are almost twice as likely as men to be afflicted

Gender difference exists by age sixPrevalence rates for anxiety disordersPopulation Group

18-24

25-34

35-44

45-54

55-64

65 and over

Total

Males 8.6 7.1 8.3 8.0 6.1 3.5 7.1

Females 13.8 12.4 14.5 15.9 9.5 5.4 12.1

Persons 11.2 9.8 11.4 11.9 7.8 4.5 9.7

Prevalence (cont’d)

More commonly associated with depression than any other disorder.

Half the people with an affective or depressive disorder in one Australian study also reported an anxiety disorder (ABS, 1998).

PHOBIA

At any given time, about 5% of the population has at least one irrational fear.

Social phobia (social anxiety disorder): fear of interacting with others or being in a social situation. Fears negative evaluations by others, so avoids potentially embarrassing situation. Common types – stage fright, fear of public speaking.

Specific Phobias: irrational fear of some object or specific situation.

Common Phobias and Their Scientific Names

Fear of Scientific Name

Washing and bathing Ablutophobia

Spiders Arachnophobia

Lightning Ceraunophobia

Dirt, germs Mysophobia

Snakes Ophidiophobia

Darkness Nyctophobia

Fire Pyrophobia

Foreigners, strangers Xenophobia

Animals Zoophobia

Agoraphobia: ‘fear of the marketplace’. Fear of being in a place or situation where escape is difficult or impossible if something should go wrong. To be in, or even think about, these situations can lead to extreme anxiety and panic attacks.Between 1-2% of the population suffer at some point in their lives (Wilson & Edwards, 1996)

OBSESSIVE COMPULSIVE DISORDER

A disorder in which intruding thoughts that occur again and again (obsessions) are followed by some repetitive behaviour (compulsions) meant to lower the anxiety caused by the thought.

Common compulsions include: hand washing, counting, touching.

Typically begin during childhood, adolescence or early adulthood

Longitudinal study found that roughly half with the disorder continued to have it over 40 years (Skoog & Skoog, 1999)

PANIC DISORDER

Characterised by attacks of intense fear and feelings of doom or terror not justified by the situation, affecting one’s ability to function in day-to-day life.

Physiological Symptoms include shortness of breath, dizziness, heart palpitations, trembling, ‘out of one’s body’ sensations, dulled hearing and vision, sweating, dry mouth and chest pains.

Psychological symptoms include fear of dying or going crazy.Attack occurs without warning and quite suddenly, lasting

between a few minutes to as long as half an hour. Most peak within 10-15 minutes.

Can often lead to Agoraphobia – fear of being in places/situations from which escape might be difficult or they may experience a panic attack.

GENERALISED ANXIETY DISORDER (GAD)

Excessive free floating anxiety and worries occurring more days than not for at least six months and have no real source that can be pinpointed, nor can the feelings be controlled.

Plain worriers – they feel tense and edgy, get tired easily, have trouble concentrating, have muscle aches and tension, sleeping problems, often irritable.

Often found occurring with other anxiety disorders and depression.

About 2% of the population have a generalised anxiety disorder.

POST TRAUMATIC STRESS DISORDER (PTSD)

Marked by flashbacks and recurrent thoughts of a psychologically distressing event (i.e. witnessing a murder, rape, victims of natural disasters).

Only about 10% of people develop PTSD following a traumatic event; violent assaults are most likely to trigger.

Symptoms: nightmares, flashbacks, avoiding thoughts or feelings about the event, hypervigilance (constant scanning), exaggerated startle response.

Often emerges only some time after the trauma. E.g. Study of Gulf War veterans found rates of PTSD more than doubled between 5 days and 2 yrs after returning home.

Can last a lifetime.

Etiology (Causes) of Anxiety Disorders

Genetics (contributes but not essential) – OCD shows particularly high heritability (85% for identical twins and 50% for fraternal)

Stressful life events – 80% of panic attack patients report a –ve life event coinciding with their first attack. Stressful childhood events predispose people to anxiety in adulthood (Barlow, 2002)

Personality, coping styles and intellectual functioning can predispose people. Studies found war veterans using avoidant coping strategies and/or with lower IQ (assessed prior to service) were more likely to develop PTSD.

David Barlow’s model of Anxiety Disorder development

Geneticvulnerabili

ty

Early experien

ce

Stress

Initial panic attack

Association of panic state with autonomic cues (e.g.

rapid pulse, sweaty palms)

resulting in learned

alarms

Anxious apprehension concerning

learned alarms

Unpredictable panic attack, triggered by

learned alarms, anxious

thoughts or provoking

stimuli

Low beliefs about self-

efficacy in

dealing with

panic

Development of avoidance

behaviour and search for stimuli associated with

safetyCognitive-Behavioural Model

Other perspectives

Psychoanalytic: repressed urges and conflicts threatening to surface – phobia as displacement, where the phobic object symbolises the true source of the fear buried deep in the unconscious.

Behaviourists: anxiety is learned – classically conditioned responses

Cognitive: result of illogical, irrational thought processes – magnification (interpreting events as being far more harmful, dangerous, or embarrassing than they actually are), all-or-nothing thinking (belief that things must be perfect – anything less is total failure), overgeneralisation (jumping to conclusions without supporting facts), minimisation (giving little or no emphasis to one’s success, positive events or traits).

Biological: GAD linked to imbalance of serotonin and GABA

Universality

Found around the world, but form may differ across culture. i.e. in some Latin American cultures, anxiety can take the

form of fits of crying, uncontrollable shouting, sensations of heat, and become high levels of aggression.

Types of phobias can be specific to different cultures – i.e. Koro: mainly in China and a few other South Asian and East Asian countries… a fear that one’s genitals are shrinkingTaijin-kyofu-sho (TKS): Japan – excessive fear and anxiety that one will so something in public that is socially inappropriate or embarrassing such as blushing, staring or having offensive body odour.

Lifetime prevalence for panic disorder is in the range of 1.4-2.9% cross-culturally (Canada, New Zealand and Lebanon)