Unit 1 Anxiety Disorders, Panic and Phobias

UNIT 1 ANXIETY DISORDERS, PANIC AND PHOBIAS Structure 1.0 Introduction 1.1 Objectives 1.2 Nature of Anxiety and Anxiety Disorders 1.3 Panic Attack: Symptoms and Clinical Features 1.3.1 A Case Study of Panic Attack 1.4 Epidemiology of Panic Attacks 1.5 Aetiology of Panic Disorder 1.5.1 Biological Factors 1.5.2 Psychological Factors 1.6 Treatment of Panic Disorder 1.7 Phobia: Symptoms and Clinical Features 1.7.1 A Case Study of Specific Phobia 1.8 Epidemiology of Phobic Disorder 1.9 Aetiology of Phobic Disorder 1.9.1 Biological Factors 1.9.2 Psychological Factors 1.10 Treatment of Phobic Disorder 1.11 Let Us Sum Up 1.12 Unit End Questions 1.13 Glossary 1.14 Suggested Readings 1.0 INTRODUCTION Feeling anxious about how to finish this large course within stipulated time? You may welcome this anxiety, at least to a certain extent. It would help you learn quickly and to get good marks. Anxiety is, indeed, a common reaction to stress. It saves us from being careless and hence from accidental disasters. Unless you have anxiety about your examination, you would not study. Unless the mother has anxiety over her baby’s health she might forget to care for the infant. Unless you have anxiety you would step over the snake and get bitten. But anxiety turns into a disorder when you are so anxious that you have a breakdown at the examination hall, forgetting everything. Anxiety is a disorder when the mother is so anxious that her baby may fall ill that she spends the day and night praying to God, and ultimately fails to feed the baby. Anxiety is a disorder when you faint if somebody names a snake. You can readily remember many such examples from your daily life. How would you recognise pathological anxiety as different from normal anxiety? What are the various 5 patterns that anxiety disorder may take? What are the causes of anxiety disorders? Generalised Anxiety Disorder How should you deal with it? In this Unit, and also in the following Units you would and Other Mild Mental Disorders learn about some such anxiety disorders. Anxiety disorder is a group of disorders each of which need special attention and understanding. You know that in classifying disorders, we usually follow either the Diagnostic and statistical Manual, Version IV TR (DSM IV TR) or International Classification of Diseases, Version 10 (ICD 10). According to DSM IV TR, the primary types of Anxiety disorders include: Panic disorder with or without agoraphobia Phobic disorders of the specific or social type Generalised anxiety disorder Obsessive compulsive disorder Post traumatic stress disorder However in this unit, we would focus on two specific anxiety disorders in detail: Panic Disorders and Phobias. You would also read case studies exemplifying the typical symptoms. The names in all case studies are fictitious and all important identifying information has been changed to maintain anonymity of the persons. 1.1 OBJECTIVES After you complete this unit, you will be able to: Define and explain anxiety and fear; Distinguish between normal and pathological anxiety; Describe the nature of anxiety disorders; Elucudate the symptoms of Panic disorder; Discuss the aetiology of Panic disorder; Elucidate the treatment of Panic disorder; Analyse Panic disorder from real life; Describe the symptoms of Phobic disorder; Explain the types of Phobic disorders; Discuss the aetiology of Phobic disorder; and Elucidate the treatment of Phobic disorder. 1.2 NATURE OF ANXIETY AND ANXIETY DISORDERS Anxiety Disorder is a blanket term that covers a number of disorders. In this context, you must be aware of the difference between fear and anxiety. Fear is a basic emotion of human beings. It is associated with the perception of a real threatening situation and involves the ‘fight or flight’ response activated by the sympathetic nervous system. If a thug attacks you in the street, you would feel intense fear. Then, you would either run for dear life, or hit him back. Thus fear involves cognition of the threatening object, subjective cognition of being in danger, physiological components like increased heart rate, and behavioural components like running or hitting. Anxiety also involves subjective perception of threat, physiological changes and some kind of behavioural reaction. But unlike fear, it has no immediate threat. If you 6 cannot go out of your home because you are always apprehending an attack from a hoodlum, it is anxiety. You are projecting the threatening situation in future and Anxity Disorders, Panic reacting to it as if it is imminent. and Phobias You may note that anxiety serves a kind of adaptive function as well, because it prepares a person for fight or flight if the danger really comes. But if the person avoids the very situation that in her perception may cause the danger, and if such imagined situations are unrealistic, then the effect becomes debilitating. Thus you may distinguish between adaptive anxiety and pathological anxiety by assessing the realistic probability of the occurrence of the object of anxiety and by assessing how dysfunctional it makes the person. Before you go into learning the specific symptoms of each, you should know the common characteristics of anxiety disorders. Cognition or subjective perception of danger which may be accompanied by vivid and occasionally morbid images of the difficulties encountered. Physiological responses through activation of sympathetic nervous system. Usually it includes increased heart rate, trembling, breathing discomfort, dilated pupils, nausea etc. On the behavioural level, there is usually a tendency to avoid the dreaded situation. However, in some cases, as in Obsessive compulsive disorder and some instances of Post traumatic Stress disorder, repetitive behaviour is also observed. In this Unit, you would learn specifically about Panic attacks and Phobias. Self Assessment Questions 1) What are the primary types of anxiety according to DSM IV TR? ..................................................................................................................... ..................................................................................................................... ..................................................................................................................... 2) State True or False beside each statement a) Fear is imaginary; anxiety is response to a really possible event ( ). b) Real and pathological anxiety can be distinguished in terms of degree of dysfunction ( ). c) Sympathetic nervous system is activated during anxiety ( ). 1.3 PANIC ATTACK: SYMPTOMS AND CLINICAL FEATURES Have you ever encountered any situation where a person has all on a sudden started behaving as if under severe stress? She sweats, almost faints and complains that she cannot breathe. People around may start thinking that she has a heart attack, but after some time she recovers and gradually becomes normal. While this may be an actual transient cardiac problem, it can also be a panic attack. Panic attack is an episode of intense fear or apprehension with a sudden onset. Such symptoms develop abruptly and usually reach its peak within 10 - 15 minutes. During such attack the victim becomes completely overpowered by the symptoms, many of which are physiological in nature. Panic attacks are characterised by their unexpectedness. The DSM IV TR mandates that a person would be diagnosed as suffering from panic disorder if she had 7 Generalised Anxiety Disorder experienced recurrent unexpected attacks and is persistently concerned with having and Other Mild Mental Disorders another attack. This condition must go on for at least one month. Also, the person must have at least four of the following thirteen symptoms during the attack: Palpitation or pounding heart Sweating Trembling or shaking Sensation of shortness of breath or being smothered Feeling of choking Chest pain or discomfort Nausea or abdominal distress Feeling dizzy, lightheaded or faint Derealisation or depersonalisation Fear of losing control or going crazy Fear of dying Paresthesias Chill or hot flushes. The typical clinical description of panic attack is featured by intense terror, at times in the form of fear of dying or going crazy. Nervousness, shaking and stress are common. The person seems to have no control on oneself. Sometimes one feels like the beginning of a heart attack, as difficulty in breathing (as if one is not getting enough air), palpitation, hyperventilation, rapid heart bits, chest pain and choking sensation along with profuse sweating predominate. Often there is a dizziness, lightheadedness, nausea and fainting. One feels dissociated from reality – one almost seems to be detached from the immediate surroundings and drawn in a whirlpool of odd sensations. Occasionally there are hot flashes or sudden chills, burning sensation in facial and neck area, tingling in fingers and toes (paresthesia). Difficulty in vision is also observed in the form of flashing vision and tunnel vision (loss of peripheral vision). The most prominent underlying characteristic is of being out of control in all respects. The reactions are usually those associated with activation of sympathetic nervous system. You must know that panic attack is not dangerous, but it can be truly frightening. There are numerous cases when the patient has been admitted for emergency cardiac care, particularly because the symptoms are mostly physiological and mimics cardiac symptoms. You need to be acquainted with the word ‘Agoraphobia’ in the context of panic

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