Anxiety & Stressor Related Disorders

Anxiety, Panic & Other Stressor Related Disorders

Among the most common of all psychiatric illnesses are anxiety disorders which can initially manifest as several physical illness states. Anxiety is a very common and normal human emotion. PMHNPs caring for clients who present for evaluation of anxiety must be able to distinguish between normal levels of anxiety and pathological levels that are symptomatic of an underlying brain-based illness. Pathological levels of anxiety require treatment and generally will need therapeutic intervention. Otherwise, it will not fully subside.

Normal emotion of anxiety:

  1. Anxiety is one of the most common human emotions.
  2. Anxiety lies on a spectrum that could extend from the absence of anxiety at one end to pathological levels that produce significant symptoms of psychiatric disorder at the other.
  3. Anxiety can be considered a healthy reaction to life stressors that acts as a motivator to deal with events and emotions.
  4. Anxiety can be pathological if it is disproportionate to events, if it is sustained over a significant time frame, if it significantly impairs functioning, or if it is apparently unrelated to any identifiable event or situation in a person’s life.
  5. High pathological levels of anxiety interfere with perceptions, memory, judgment, and motor responses.

ANXIETY DISORDERS

The most common group of psychiatric disorders are anxiety disorders which are characterized by the degree to which the client experiences anxiety, by the duration and severity of the anxiety, and by the usual behavioral manifestation of anxiety observed in the client. Accompanied by multiple somatic symptoms, anxiety may range from acute states to chronic disorders.

  • Panic Disorder
  • Agoraphobia
  • Specific Phobia
  • Social Anxiety (Social Phobia)
  • Selective mutism
  • Generalized Anxiety Disorder
Therapist Talking To Client — Germantown, MD — Supreme Healthcare & Wellness Services LLC

PANIC DISORDER

Panic disorder is experienced as isolated episodes or attacks with sudden onset of intense apprehension, fearfulness, or terror, often associated with sense of impending doom.

  • Attacks occur without warning and in the absence of any real danger.
  • Attacks build to a peak of intensity within a short, self-limiting time, usually within 10 minutes of onset.
  • It is more common in women than in men.
  • After first attack, persistent concern over having another attack, worry over the consequences of initial attack, or a significant behavioral change related to attack
  • With high somatic sensations, clients are often sensitive to new somatic experiences or perceptions.
  • Frequently intolerant of or concerned with common side effects of medication treatments
  • Discouraged or ashamed about “failure” to control emotions and over concern about dying when no other pathology identified
  • In two-thirds of cases, major depression occurs first, followed by panic disorder symptoms.
  • In one-third of cases, panic disorder symptoms lead to major depression symptoms

AGORAPHOBIA

Agoraphobia is described by avoidance of places or situations from which escape may be difficult or embarrassing or in which help may not be available in the event of perceived need, such as a panic attack. Up to 50% of people meeting criteria for agoraphobia report panic attacks or panic disorder preceded onset of agoraphobia.

  • Anxiousness usually leads to avoidant behavior that impairs a person’s ability to travel, to work, or to carry out tasks of daily living.
  • Differential diagnosis is assisted by the awareness that people with agoraphobia feel better and report less significant concerns with anxiety when accompanied by a trusted companion.
  • When people meet criteria for agoraphobia and panic or other anxiety disorder, both diagnoses should be assigned

SOCIAL ANXIETY (PHOBIA) DISORDER

Social anxiety disorder is a marked and persistent fear of social or performance situations in which embarrassment may occur. Anxiety levels often are sufficient to fit criteria for a situationally bound panic attack. The disorder has an estimated 3% to 13% prevalence rate among the U.S. population. Rates are equal for the genders.

Monitor for the following:

  • Some degree of social anxiety is common and normative in adolescence.
  • Social phobia should be diagnosed only if symptoms persist for longer than 6 months.
  • Onset is in the mid-teens, often following stressful or humiliating experience, and tends to remit with age.
  • Differential diagnosis is assisted by awareness that people with social phobia do not feel better or experience decreased anxiety when accompanied by a trusted companion.
  • Common descriptive features: Hypersensitivity to criticism. Negative self-evaluations. Sensitivity to rejection. Low self-esteem. Inferiority feelings. Lack of assertiveness.

GENERALIZED ANXIETY DISORDER (GAD)

  • In GAD, unwarranted worry, apprehension, or anxiety about events or activities occurs more days than not for a period of at least 6 months.
  • They find it hard to control the anxiety.
  • There is no clear link exists to life events or stressors.
  • Worry and anxiety often interfere with activities of daily living.
  • The nature and focus of worry change frequently.
  • There is a pattern of waxing and waning of symptoms.

OBSESSIVE–COMPULSIVE AND RELATED DISORDERS:

  • Obsessive–Compulsive Disorder
  • Body Dysmorphic Disorder
  • Hoarding Disorder
  • Trichotillomania (Hair Pulling Disorder)
  • Excoriation (Skin-Picking Disorder)
  • Substance- or Medication-Induced Obsessive–Compulsive and Related Disorder

OBSESSIVE–COMPULSIVE DISORDER (OCD)

  • OCD is the manifestation of anxiety-provoking obsessions or compulsions that function to reduce the person’s subjective anxiety level.
  • Obsession is defined as recurrent and persistent thoughts, impulses, or images that are experienced and cause anxiety and distress
  • Experienced as intrusive and inappropriate
  • Ego-dystonic experience that makes a person feel the content of obsession is foreign to his or her belief structure and not the kind of common thought, impulse, or image he or she usually experiences
  • Compulsion is defined as repetitive behaviors or mental actions that a person feels driven to perform in response to an obsession.

DISSOCIATIVE DISORDERS:

Dissociative amnesia, depersonalization or derealization, and dissociative identity disorder (DID)

  • Dissociation is a defense mechanism that protects a person from overwhelming anxiety by emotionally separating. Dissociation causes gaps or interruption in the person’s memory
  • Depersonalization or derealization: A persistent feeling of oneself not being real, or the environment not being real; reality testing remains intact. Depersonalization and derealization are generally perceived as uncomfortable.

Etiology of depersonalization and derealization can be physical or psychological:

  • Physical causes are seizures, migraine headaches, psychedelic drugs, and alcohol.
  • Psychological causes are severe anxiety and traumatic stress.

Dissociative identity disorder (DID) is characterized by two or more distinct personality states which alters.

  • It is a personality state that generally split off from one another, leading to gaps in recall of everyday events.
  • Symptoms causes significant distress and impaired functioning.
  • Comorbidity with PTSD.
  • Etiology is a history of severe physical or sexual trauma, or both, in childhood.

BODY DYSMORPHIC DISORDER

  • Preoccupation with one or more perceived defects or flaws in physical appearance
  • Engages in repetitive behaviors such as checking mirror, reassurance-seeking, etc. in response to appearance concerns
  • Preoccupation causes considerable distress
  • Insight ranges from good, to poor, and to absent (fixed delusion)

HOARDING DISORDER

  • Constant difficulty discarding possessions, regardless of actual value
  • Experiences marked distress in response to pressure to discard items
  • Results in accumulation of possessions that compromise living space or ability to function, including maintaining a safe environment for self or others
  • Insight ranges from good, to poor, and to absent (fixed delusion)

TRICHOTILLOMANIA

  • Recurrent pulling out of one’s hair despite repeated attempts to stop
  • Causing significant distress or impairment in functioning
  • Hair-pulling is not an attempt to improve a perceived defect or flaw

EXCORIATION DISORDER

  • Recurrent skin picking that results in lesions despite attempts to stop
  • Results in significant distress or impairment
  • Behavior not better explained by physiologic response to substance (e.g., methamphetamine use) or intentional attempt at self-harm

TRAUMA AND STRESSOR RELATED DISORDERS

  • Reactive Attachment Disorder
  • Disinhibited Social Engagement Disorder
  • Post-Traumatic Stress Disorder
  • Acute Stress Disorder
  • Dissociative Identity Disorder
  • Dissociative Amnesia
  • Depersonalization or Derealization Disorder

If you are one of many individuals who struggle with anxiety, give our office a call! Our patients are our mission. (855) 208-0890

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