Anxiety and Mood Disorders Anxiety

Anxiety and Mood Disorders

Anxiety disorders: An overview

Anxiety -related disorders are some of the most common conditions amongst individuals suffering from psychological distress. Anxiety "is one of the most prevalent of all psychiatric disorders in the general population," and many individuals anecdotally report having sub-clinical phobias. Phobias are the most common of all anxiety disorders, "with up to 49% of people reporting an unreasonably strong fear" and up to 25% with debilitating phobias (Rowney & Hermida 2011: 1). "Social anxiety disorder [social phobia] is the next most common disorder of anxiety, with roughly 13% of people reporting symptoms" that meet the Diagnostic and Statistical Manual of Mental Disorders Text Revision (DSM IV-TR) criterion. Post-traumatic stress disorder afflicts "approximately 7.8% of the overall population and 12% of women, in whom it is significantly more common. In victims of war trauma, PTSD prevalence reaches 20%" (Rowney & Hermida 2011: 1).

While everyone experiences anxiety from time to time, anxiety-related disorders severely impair the individual's ability to function in the world and have a negative impact upon the individual's social relationships. For example, a phobia, as opposed to an aversion is defined as a fear that is "excessive or unreasonable" by the DSM IV-TR (Rowney & Hermida 2011: 1). Some individuals may dislike driving over bridges, but a person with a phobia may have to pull over by the side of the road and ask his or her driving companion to go over the bridge or he or she will significantly alter his or her route to avoid going over bridges.

Social anxiety disorders can be isolating, given the impact they can have upon the individual's ability to enjoy a normal social and working life. Other forms of anxiety disorders are less focused upon one, specific issue and instead manifest themselves as a general sense of dread. Generalized Anxiety Disorder (GAD) patients often are convinced that they have physical complaints because of the racing heartbeat and panic attacks that accompany the illness. With GAD, patients manifest anxiety about most components of their life, rather than a single aspect of it. 60% of sufferers of GAD have comorbidities, including mood disorders such as major depression (Rowney & Hermida 2011: 1). Alcoholism and phobias such as agoraphobia are also frequently manifested together (Rowney & Hermida 2011: 1).

Obsessive-compulsive behavior presents itself in a different fashion. With OCD, sufferers feel anxiety if they do not perform certain compulsive, repeated actions. Washing one's hands, checking on locks or to see if the stove is turned off are common examples. Some sufferers also experience unwanted, unpleasant thoughts or obsessions which cause anxiety. OCD appears to have a strong genetic component -- the behavior pattern tends to run in families. In contrast, disorders such as Posttraumatic Stress Disorder (PTSD) are associated with a traumatic or violent event, such as witnessed during an accident, war, or as the result of a personal trauma such as a rape.

Mood disorders

Mood disorders fit into two primary categories, that of unipolar depression and bipolar disorder (once commonly known as manic depression). Within these two generalized categories, there are different subsets. Major depression, according to the U.S. Surgeon General, ranks as one of the top ten psychological disabilities in the world. It is more commonly diagnosed in women. According to the DSM criteria, patients with a major depressive disorder are significantly impacted by a feeling of depressed mood, guilt, hopelessness, and often suicidal thoughts. They also often suffer chronically from a loss of appetite or excessive appetite, and either have trouble sleeping or sleep constantly, due to the fatigue and weariness that is common to the condition. The symptoms of the disorder must be present for at least two weeks for the diagnosis (Mood disorders, 2011, Mental Health: A report of the Office of the Surgeon General).

Dysthymia, or mild depression, is a more mild form of depression, but lasts for far longer duration. The diagnostic criteria require that the patient manifest the illness for at least two years. The symptoms are similar to that of major depression, but less incapacitating. A person with dysthymia may not be actively suicidal or have trouble getting out of bed in the morning, but he or she is plagued by a nagging sense of despair and worthlessness that sap the joy out of life.

The other major category of mood disorder is that of bipolar disorder and cyclothymia. Bipolarity manifests itself in rapid, extreme mood shifts from mania to depression. Manic periods are often preceded by a hypomanic phase, in which the person is extremely productive, needs little sleep, and may feel extremely confident and creative. However, the risk-taking behavior grows more marked as the patient enters the fully manic phase, and the sufferer becomes increasingly distracted, grandiose, and unpredictable in his or her behavioral patterns. At its most extreme, mania may be misdiagnosed for schizophrenia because of the patient's delusions of grandeur. Depression amongst the bipolar is often more extreme and results in complete catatonia and suicidal despair.

With cyclothymia, the patient exhibits hypomanic symptoms and less extreme depressive episodes. "The risk of bipolar disorder developing in patients with cyclothymia is about 33%; although 33 times greater than that for the general population, this rate of risk still is too low to justify viewing cyclothymia as merely an early manifestation of bipolar type I disorder" (Mood disorders, 2011, Mental Health: A report of the Office of the Surgeon General). Like dysthymia, the symptoms of cyclothymia must cause significant social or personal impairment to be classified as a disorder.

Treatment

Both mood and anxiety disorders are commonly treated with a combination of therapy and psychopharmacology. Cognitive-behavioral therapy (CBT) is generally considered to be the most effective treatment for anxiety disorders. CBT challenges patient's maladaptive responses (such as excessive worrying, checking, and obsessing) with confrontational, rationally-based questions and replaces current habits with new patterns of thinking and coping mechanisms to deal with stress. Clients are encouraged to monitor themselves, and when they note "patterns of worrisome thinking, catastrophic imagery, physiological activity, behavioral avoidance, and the external cues that may trigger these responses," they replace them with the "newly learned coping responses" (Newman & Borkovec 1995). Anxiety disorders are also treated with medications, including selective serotonin reuptake inhibitors (SSRIs) such as Prozac, which increase the patient's levels of serotonin in the brain, thus relieving anxiety.