Anxiety disorders: overview and clinical characteristics

Anxiety disorders are a varied and complicated set of physical and psychological problems that affect more than twenty million Americans. The disorders, which include general anxiety disorder (GAD), panic disorders, and phobias, can often exert a disabling influence upon the individual's life, and disrupt his or her personal and social interactions. Treatments focus upon helping the individual to identify and understand the irrationality of their anxiety, and to assist them in facing up to their fears.

Anxiety

Anxiety is, "one of the main motivating forces in much of human behavior" (Beck & Emery, 1985, p. 13), and is a normal reaction to a threatening object or situation. It produces a wide range of physiological and psychological effects that are often described as preparing the body for primitive 'fight or flight'. These symptoms result from the increased amount of adrenaline that is produced by the sympathetic nervous system, which causes an increase in the heart and respiration rate, the raising of blood pressure, and the contraction of blood vessels in the skin and intestines as blood is diverted to the heart, lungs and muscles (P.H.R., 1997). Although these reactions are appropriate when faced with incidents of threat or danger, if this level of anxiety continues after the threat has been removed, or if no real threat exists, these physical and psychological symptoms can lead to the development of anxiety disorders.

Anxiety Disorders

Anxiety disorders are described as," various combinations of physical and mental manifestations of anxiety, not attributable to real danger, and occurring either in attacks or as a persisting state" (Sainsbury, 1980, p. 215). Anxiety disorders affect over 20 million Americans, almost half of whom suffer from its most common condition, general anxiety disorder (GAD), the other anxiety disorders being panic attacks (panic disorder), and phobias. (P.H.R., 1997).

General anxiety disorder (GAD).

Studies show that GAD affects between two and five percent of the population, and is considered to account for almost a third of all psychiatric consultations (P.H.R., 1997). GAD may have an acute onset and appear severe in intensity, or it may occur in a chronic form, with the severity fluctuating with in relation to stress factors. This form of anxiety is described as 'free-floating, or diffuse, as it is not associated with any specific situation or object, and it causes sufferers to experience a continual feeling of concern and tension. Somatic symptoms of GAD include difficulty in sleeping; lightheadedness or shortness of breath; palpitations; excessive sweating; pallor; and digestive problems. As a result, many sufferers of GAD tend to feel tired, have trouble concentrating, and sometimes suffer from depression (Sainsbury, 1980). GAD affects people of both sexes and all ages and, although it is diagnosed more frequently in women than in men, this statistic is misleading as only a quarter of GAD sufferers seek professional treatment (P.H.R., 1997).

Panic attacks.

A panic attack is characterized by unpredictable attacks of severe anxiety that involve symptoms that are not related to any particular situation or object. (Beck & Emery, 1985). In many cases, the individual may be completely unaware of the cause, but the associated symptoms can certainly not go unnoticed. These effects include palpitations; lightheadedness; chest pains; uncontrollable shaking or trembling; nausea; and disorientation. A few of the factors that are considered to contribute to panic attacks include heredity; hyperventilation; and psychological factors (P.H.R., 1997). Research suggests that panic disorder is often hereditary, with first degree relatives of patients having four to seven times greater risk than the general population. Chemical changes within the body have also been highlighted as a contributory factor, with the levels of neurotransmitters, such as nor-epinephrine, gamma-aminobutyric acid (GABA), and serotonin, considered to play an important role in the cause and continued presence of the condition. Hyperventilation has long been associated with anxiety, due to its ability to rapidly cause a decrease in carbon dioxide in the blood (P.H.R., 1997).

Phobias.

Phobic disorders are characterized by an, "intense dread of certain objects or specific situations which would normally not have such an effect" (Sainsbury, 1980, p. 222). The resulting anxiety is extreme and disabling, and unlike the free-floating anxiety that exists in GAD, phobic disorders arouse anxiety that becomes attached to a specific object or situation. The individual is aware that these situations or objects poses no 'real' fear, and they are therefore aware that their anxiety is irrational. Most people that suffer from phobias attempt to manage their anxiety by ensuring complete avoidance of the phobic situation or object, which can have disabling psychological and physical effects. Phobic disorders can be broadly grouped into social phobias and specific phobias. Social phobias include; the fear of open spaces (agoraphobia); the fear of closed spaces (claustrophobia); fear of blushing in public (erythrophobia); and stage fright. Specific phobias occur most commonly in relation to certain animals, insects, injuries or diseases (Sainsbury, 1985).

Treatment