Anxiety Disorders, OCD, PTSD: Symptoms, Risk Factors and Treatment
Risk Factors and Therapy for Anxiety Disorders, OCD, PTSD
What are Anxiety Disorders?
Therapy for anxiety disorders is recommended when anxiety symptoms markedly and consistently interfere with your daily functioning for six months or more. Occasional feelings of anxiety are a normal part of our life. You might experience anxiety before taking an exam, making an important decision or dealing with a challenging task at work.
However, anxiety disorders encompass more than transient fear or worry.
For an individual with an anxiety disorder, feeling anxious is a persistent state that deteriorates over time. As a result, it highly interferes with daily functioning. Anxiety seriously affects interpersonal relationships, job or academic performance.
Common anxiety disorders include
- generalised anxiety disorder (GAD),
- panic disorder,
- phobia-related disorders.
Obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) are no longer mentioned as anxiety disorders in the DSM-5 and belong to their own categories. Nevertheless, I will briefly introduce them in this article, as these conditions are closely linked to anxiety disorders.
Generalised Anxiety Disorder (GAD)
GAD manifests in disproportionate or excessive feelings of worry or anxiety for at least half a year almost every day. Individuals with GAD excessively worry about various things, such as daily routine, health, work, finances and other probable life uncertainties. Consequently, this worry leads to significant distress in daily functioning, including work, studies and social life.
GAD symptoms comprise
- feeling on edge or agitated,
- irritability,
- fatigue,
- difficulty concentrating,
- muscle tension,
- mind going blank,
- troubled sleep,
- troubles controlling worry.
Panic Disorder
Individuals with panic disorder suffer from recurring panic attacks. Panic attacks are sudden moments of severe anxiety and fear that intensify rapidly and peak within several minutes. Attacks can happen unpredictably or due to a trigger, such as a feared situation.
Typical panic attack symptoms comprise the following:
- heart palpitations, a faster heart rate or a pounding heartbeat;
- feelings of choking or shortness of breath;
- feelings of imminent doom;
- feelings of losing control.
- trembling or shaking;
- sweating.
People with panic disorder usually fear the consequences of panic attacks and worry about when the next attack will occur. Thus, they actively try to avert future attacks by avoiding circumstances, places or actions they associate with panic outbursts. This avoidance often develops into agoraphobia, which accompanies panic disorder. Trying to avoid attacks and worrying about the consequences of panic attacks cause substantial troubles in various areas of life.
Phobia-Related Disorders
A phobia is an intense fear of—or aversion to—specific situations or objects. Although it can be natural to be scared in some circumstances, the dread experienced by people with a phobia is disproportional to the actual threat.
People with a phobia
- may have an irrational or extreme worry about facing the feared situation or object;
- actively avoid the feared situation or object;
- experience instant severe anxiety upon encountering the feared situation or object.
There are several forms of phobias and phobia-related disorders:
Specific Phobias
As the name suggests, individuals with a specific phobia have an intense fear of particular situations or things. Examples of specific phobias include the fear of
- injections,
- blood,
- specific animals (such as snakes and spiders),
- heights,
- flying,
- swimming.
Social Anxiety Disorder (formerly called social phobia)
Individuals with social anxiety disorder have an extreme fear of social or performance events. They worry that others will negatively appraise their behaviours or actions related to their anxiety. In addition, such individuals are hypersensitive to feeling embarrassed. As a result, fear of social events often causes affected individuals to avoid social situations. Social anxiety attacks can occur in many different environments, including the school or workplace.
Agoraphobia
Individuals with agoraphobia have an excessive fear of two or more of the following situations:
- being in enclosed spaces,
- being in open areas,
- being outside of the home alone,
- using public transportation,
- being in a crowd.
People with agoraphobia usually avoid the mentioned environments. They think being able to leave such a situation might be problematic or impossible in the event panic-like symptoms or other embarrassing incidents happen.
Post-Traumatic Stress Disorder (PTSD)
PTSD arises as a delayed or extended response to a stressful situation–a catastrophic or threatening event. Predispositions, such as a personality trait or history of neurotic illness, may alleviate or aggravate the course of the disorder. Yet, these predispositions are neither essential nor sufficient to explain the incidence of PTSD.
Typical PTSD symptoms include
- episodes of re-experiencing the traumatic event (awake and in sleep) mainly in the form of persistent nightmares and flashbacks;
- chronic hyperarousal and hypervigilance;
- diminished concentration;
- insomnia;
- exaggerated startle reaction;
- avoidance of situations and activities that are reminders of the trauma;
- avoidance of recollections of the dangerous event;
- numbing (e.g. psychogenic amnesia).
It is usual to have some of these symptoms for a few weeks after a traumatic event. However, they may be PTSD if they last more than a month, seriously interfere with your daily functioning and are not due to medical illness, substance use or anything except the trauma itself.
The inception of the disorder follows the traumatic event with a latency period that may range from weeks to several months. The course of the illness is unstable, but most individuals are likely to recover. In some cases, the disorder may chronically progress over many years and ultimately evolve into a permanent personality change.
Obsessive-Compulsive Disorder (OCD)
OCD is characterised by
- recurrent obsessions—repeated intrusive, upsetting thoughts;
- compulsions—an irresistible urge to do something to make the thoughts disappear. It may provide relief from the tension that functions as a source of despair and anguish.
Examples of obsessions are feeling “not just right”, imperfect, ritualistic obsessions and a fear of getting contaminated or hurt by others. Compulsions often include cleaning, checking on things, counting or washing your hands, compulsive actions related to ”not just-right” feelings and ritualistic compulsions. Untreated, obsessive-compulsive disorder can dramatically affect your life. The symptoms often start in the childhood or teenage years.
Risk Factors of Anxiety Disorders
Research indicates that the interaction of environmental and genetic influences contributes to the risk of developing anxiety disorders. Although the risks for each type of anxiety condition can vary, some common factors for all anxiety disorders include the following:
- behavioural inhibition in childhood or personality traits of shyness;
- adverse stressful life experiences;
- a history of anxiety or other mental illness in biological relatives;
- some physical conditions, including heart arrhythmias or thyroid complications.
Caffeine or other substances/medicines can generate or aggravate anxiety. A physical health inspection is beneficial for the assessment of an anxiety disorder.
Therapy for Anxiety
Psychological therapy, medication or both may be effective for treating anxiety disorders. There are several approaches to treating anxiety, and individuals should work with their mental health therapist to choose the best treatment.
Cognitive Behavioural Therapy (CBT) for Anxiety
CBT is an evidence-based psychological therapy that has proven its value in treating anxiety disorders. Cognitive behaviour therapists teach people how to think differently, modify their mindset and rationally appraise anxiety-generating stimuli to behave functionally and stop feeling overwhelmed with their worries. Moreover, CBT helps people acquire and practice social skills essential for dealing with social anxiety.
Cognitive and exposure therapies are two CBT techniques employed by mental health therapists in treating anxiety disorders. Cognitive therapy focuses on identifying, challenging and then neutralising maladaptive or dysfunctional thoughts, which trigger anxiety. Exposure therapy aims at confronting specific fears underlying an anxiety disorder to assist people in engaging in activities they have been trying to avoid. Exposure therapy is effective when combined with mindfulness, relaxation practises and imagery. In addition, homework tasks may help enhance therapy outcomes.
Anxiety Medication
Medications can markedly alleviate anxiety symptoms in the short term. Psychiatrists are doctors who usually prescribe medications and plan pharmacological therapy for anxiety. These prescriptions typically include anti-anxiety drugs (e.g. benzodiazepines), beta-blockers and antidepressants. Furthermore, it is critically important to assess for comorbid conditions (e.g. depression or substance use disorders).
Some medications may be more effective for specific anxiety disorders. Thus, individuals should work watchfully with their psychiatrist to establish which pharmacological intervention is best for them. In addition, patients should discuss with their doctor which substances they should avoid. Certain substances, such as some herbal ingredients, non-prescription cold medications and illicit drugs, may exacerbate anxiety symptoms or interfere with prescribed anxiety medications.
Stress Management Techniques for Anxiety
The inability to relax is a fundamental feature of a person suffering from anxiety. Therefore, stress management techniques, including relaxation and mindfulness, can improve therapy’s effects by helping individuals with anxiety calm themselves.
Bibliography:
- Anxiety Disorders in Adults. DOI: 10.1093/med:psych/9780195116250.001.0001