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Anxiety disorders
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Generalized Anxiety

Generalized anxiety is characterized by persistent concerns, prone to excess and uncontrollable, that persist since at least six months and that often come with physical symptoms.

The person suffering from generalized anxiety will behave with excessive vigilance concerning any everyday life events. He will always fear that misfortunes are about to occur. He is always waiting for an imminent catastrophe.

We can diagnose someone with generalized anxiety when the following symptoms last for more than six months.

The person:

  • Often suffers from insecurity (fear of not having enough money, fear of losing one's job).
  • Is worried on a daily basis for one's parents and friends although nothing would justify it.
  • Often suffers from insomnia and is regularly awaken at night.
  • Has difficulty to relax.
  • Trembling or shaking
  • May suffer from muscular tension
  • May suffer from headaches (tension headache)
  • May experience symptoms like nausea, diarrhea, abundant perspiration, palpitations, accelerated pulse.
  • May suffer from irritability.
  • May feel the need to urinate often.
  • May suffer from chronic tiredness.
  • Feeling of choking.
  • May have problems concentrating.
  • May even suffer from a depression.

The individual suffering from generalized anxiety will have a great sensibility toward sounds, smells, temperature shifts, ambiance. He will easily be startled as one quietly approaches. Upon learning about catastrophes in the world, he will tend to react more strongly than the average person.

We can figure generalized anxiety with the following example:

Marie went out to do some shopping a few blocks from her home. Upon hearing firefighter sirens, she will speed up her activities to return as quickly as possible to check if her domicile is not on fire. Marc phones home everyday at the same time to make sure his teenagers are back from school. If by any chance one is late, he will panic, thinking of the worst: an accident, an aggression, etc.

Panic Attack

Panic is a normal reaction when facing an imminent danger. It sets off a group of physical as well as emotional reactions. However, when this reaction arises without any real dangerous situation, it is then referred to as a 'panic attack'.

A panic attack is a well defined anxiety or unrest period characterized by a fear or terror associated with physical sensations usually found in a situation of imminent catastrophe. The panic attack is reflected by at least 4 of the following physical symptoms:

  • Palpitations.
  • Accelerated heart rate.
  • Trembling or shakings.
  • Perspiration, cold sweats.
  • The sensation of choking, of lacking air....
  • Feeling like choking
  • Chest pain.
  • Feeling dizzy, unsteady, lightheaded.
  • Fear to faint.
  • Numbness and tingling
  • Nausea, digestive or abdominal distress.
  • Muscular weaknesses.
  • Chills or hot flushes.
  • Fear to lose control, to go crazy.
  • Fear of dying.
  • Depersonalization, sensation of being disconnected from one's body.
  • Impression of being outside reality.


Panic Disorder

There are people who have one or more panic attacks who consult their doctor and learn that it was all caused by 'nerves'. They feel reassured, hence changing their way of living and solve their problem.

Others will live in fear of the next panic attack and will be sensitive to their bodily reactions. They panic for every symptom. The fear of having a panic attack suffices in setting off a real one. It has then turned into a 'panic disorder'.

The main characteristic of panic disorder is the presence of recurring and unsuspected panic attacks followed by persistent fear – for at least one month – of suffering from yet another panic attack; it is also the presence of preoccupations regarding possible implications or regarding consequences of those panic attacks. Here is the pattern of panic disorder:

  • Constant fear of a new attack.
  • Physical symptoms.
  • Increased fear, escape or fight response.
  • Increase of symptoms.
  • Fear becomes panic.

Panic attacks may be of three types, depending on their level of predictability and occurrence :

1. Related to a situation (you know that in a given situation, for example in the metro, you will panic).
2. Made more likely by a situation (you already had a panic attack in a specific situation, a shopping mall for example, but you do not know if it will reoccur).
3. Unsuspected (you cannot predict when a panic attack might occur).

Agoraphobia

Anxiety related to the fact of being in places or situations from where the person thinks it would be difficult or troublesome to escape or find help in case of feeling faint.

Agoraphobic fears put together a group of characteristic situations among which the fact of being alone outside of one's domicile; of being in a crowd or a waiting line; on a bridge or on a bus, on a train or in a car.

Progressive avoidance of all public places might eventually reduce one's liberty of movement and seriously handicap one's social as well as professional life, given that the person will often stay home for a lack of accompaniment to go around.

When we fear the outbreak of a panic attack, we feel like being in a safe place or with a close relative who understands us, if a new panic attack occurs, in a way to be quickly taken to the hospital or go to lie down at home (since the domicile if often perceived as a secure place). On top of the escape being difficult (like getting out of an elevator in motion or leaving a movie theater during a film), the situation might occasion substantial embarrassment for the individual subject to it (other people's stare, for example).

Agoraphobia leads to avoidance of situations such as :

  • Finding oneself in a crowd, in a public area;
  • Traveling by car, train, plane, bus or metro;
  • Being on a bridge, a highway, an overpass or a tunnel;
  • Getting in an elevator;
  • Going to a movie theater, to a theater, to the restaurant;
  • Going to shop at the supermarket; at the shopping mall;
  • Going to the bank;
  • Going to the dentist, the doctor, the hairdresser;
  • Being alone outside home or home alone.

Social Phobia and Social Anxiety Disorder

Anxiety or social phobia, severe anxiety disorder.

It is a pronounced fear of others' judgment in all interpersonal social situations or any situation where one is being watched, in which an intense feeling of embarrassment might arise. Exposition to such situations almost inevitably provokes an anxious response which may lead to a panic attack. This fear generally leads to avoidance of such situations.

Interpersonal social situations

  • Speaking in public
  • Eating and drinking in front of others.
  • Writing in front of one or more people.
  • Getting in or out of a room where people are already seated.
  • Performing teamwork ( for studies or at work).
  • Playing a team sport where one can be watched.
  • Using public restrooms.
  • Siting in a waiting-room.
  • Geting in an elevator; on a bus or a train crowded with people.
  • Passing in front of a group of people.

There are three levels of social inhibition :

1. Simple shyness
Or occasional nervousness when one feels a slight inconvenience.

2. Social Anxiety Disorder
When the person feels more pronounced symptoms such as blushing, shaking or trembling, chills or hot flushes, abdominal distress, palpitations, etc.

3. Social Phobia
When a one is indisposed by severe physical symptoms that may lead to panic, one ends up avoiding all the situations in which she may feel these symptoms. Despite avoidance behaviors, psychosocial suffering is always there given that feelings of distress and social isolation result from from it. Many social phobics are unable to work outside and have a social or affective life. Some school drop outs may be related to youth's social phobia.

**DSM IV criteria for diagnostic (Most common manual).

A. 1. A marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing. Note: In children, there must be evidence of the capacity for age-appropriate social relationships with familiar people and the anxiety must occur in peer settings, not just in interactions with adults.

B. 2. Exposure to the feared social situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally predisposed Panic Attack. Note: In children, the anxiety may be expressed by crying, tantrums, freezing, or shrinking from social situations with unfamiliar people.

C. 3. The person recognizes that the fear is excessive or unreasonable. Note: In children, this feature may be absent.

D. 4. The feared social or performance situations are avoided or else are endured with intense anxiety or distress.

E. 5. The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person's normal routine, occupational (academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.

F. 6. In individuals under age 18 years, the duration is at least 6 months.

G. 7. The fear or avoidance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition and is not better accounted for by another mental disorder (e.g., Panic Disorder With or Without Agoraphobia, Separation Anxiety Disorder, Body Dysmorphic Disorder, a Pervasive Developmental Disorder, or Schizoid Personality Disorder).

H. 8. If a general medical condition or another mental disorder is present, the fear in Criterion A is unrelated to it, e.g., the fear is not of Stuttering, etc.

*source : www.anxietesociale.org

Obsessive-Compulsive Disorder

Disorder characterized by repetitive and embarrassing ideas (obsessions)or behaviors (compulsions). The person recognizes the abnormal character of the disorder but cannot control it.

Obsessions are ideas, images or impulsions that often take over the thought of the subject against one's will and lead to anxiety, concentration difficulties as well as memory impairments. What distinguishes an obsession from a belief, in the subject suffering from the disorder, is that he will recognize that his obsessive fears are the product of his own mind even though he feels the urge to abide by them.

Here are the most common obsessions

  • Fear of contamination by germs, dust, etc.
  • Thought of being injured or having injured someone else.
  • Fear of causing a fire or water damage by not having turned off the oven or shut the tap even after checking many times.
  • Imagining oneself losing control over hostile or violent impulses.
  • Disagreeable thoughts or imperious sexual needs.
  • Excessive moral or religious doubts.
  • The urge to place things in a particular order.
  • The urge to speak, ask or confess.

Compulsions are repetitive acts, often taking place according to certain rules, performed to lessen anxiety caused by obsessions.

Here are the most common compulsions :

  • Someone obsessed with cleanliness may wash hands repeatedly until the hands' skin is bared or bleeds.
  • A person may verify many times :
       - if the house or the car is well locked.
       - if the stove or iron are turned off.
       - if the tap is well shut.
       - if a to-be mailed letter is effectively paid for.
       - if the keys were not forgotten.
  • Someone who continually wonders if he hit someone with his car may drive in the same area for hours on end until doubts dissipate.

Contrary to other compulsive behaviors (like gambling), these compulsions procure no pleasure. The obsessed person will perform them to dissipate troubles or worries sparked off by the corresponding obsession.

Specific Phobia

Specific phobia consist of an important and persistent fear set off by the presence or the possibility of being in contact with an object, an animal, or being in a specific situation. The object of fear is clearly defined. The person cannot control this fear. If he cannot avoid or flee from the object of fear, he will experience a great suffering or distress in its presence.

Specific phobia can be found in the following types of fear :

  • Of animals and insects (specifically spiders).
  • Of elements and natural environment, (tornadoes, storms).
  • Of blood (injuries, blood sampling, transfusions).
  • Of germs and diseases.
  • Of specific situations (being victim of theft, of violence).
  • Of closed spaces (elevators, closets, closed rooms).
  • Of trips or means of transportation (air flights, trains, boats, bus, metros).

 

Posttraumatic Stress Disorder or Anxiety

This disorder may appear when a person has been exposed to particularly traumatizing situations such as mugging, a robbery, being taken hostage, a fire, an accident, etc. It may occur that the disorder also appears in a people who have been witnesses of a traumatizing event or when they have been involved indirectly.

For most people, after a catastrophic event, a normal reaction will last less than two days and will not last beyond four weeks. However others may feel persistent and acute psychological or physical symptoms that impede them from functioning normally.

We refer to posttraumatic stress disorder when the perturbation leads to suffering or a shift in social, professional or other important domains' functioning. The memory of the event is often of extraordinary precision.

People reexperience the event as if they were still there. The images, the memories of screams, of smells, etc., seem more vivid that ordinary memories. Luc, for example, was telling us how he only needs to 'look' at these images to tell us of how many footsteps he has done to reach victims, etc.

Here are the American Psychiatric Association criteria that are generally used :

A. The person was exposed to traumatic events as previously defined.

B. The traumatic event is persistently reexperienced, in one (or many) of the following ways :

  • 1. recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
  • 2. recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.
  • 3. acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur.
  • 4. intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
  • 5. physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:

  • 1. efforts to avoid thoughts, feelings, or conversations associated with the trauma
  • 2. efforts to avoid activities, places, or people that arouse recollections of the trauma
  • 3. inability to recall an important aspect of the trauma
  • 4. markedly diminished interest or participation in significant activities
  • 5. feeling of detachment or estrangement from others
  • 6. restricted range of affect (e.g., unable to have loving feelings)
  • 7. sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:

  • 1. difficulty falling or staying asleep
  • 2. irritability or outbursts of anger
  • 3. difficulty concentrating
  • 4. hypervigilance
  • 5. exaggerated startle response

We refer to posttraumatic stress disorder when the perturbation leads to suffering or a shift in social, professional or other important domains' functioning. The memory of the event is often of extraordinary precision.

People reexperience the the event as if they were still there. The images, the memories of screams, or smells, etc., seem more vivid that ordinary memory. Luc, for example, was telling us how he only needs to 'look' at these images to tell us of how many footsteps he has done to reach victims, etc.

Posttraumatic stress disorder are, according to many researchers, the outcome of the organism's adaptation mechanisms.

  • For example, hypervigilance symptoms and other physiological overactivation occur as if one had to stay alert to make sure to do what is needed to prevent other dangers.
  • The dulling of emotions and amnesia allow one to manage stress, etc.
  • The problem, when one does not recover, is that these mechanisms are maintained while no longer being necessary and while bringing forth too many inconveniences.

It may happen that these symptoms of posttraumatic stress disorder are followed by physical or psychological symptoms of anxiety or panic (it is in fact hyperventilation) such as :

  • Palpitations,
  • accelerated heart rate or pounding heart,
  • sweating,
  • trembling or muscular shaking,
  • sensations of shortness of breath or smothering,
  • feeling of choking,
  • chest pain or discomfort,
  • nausea or abdominal distress,
  • feeling dizzy, unsteady, lightheaded or faint,
  • derealization (feelings of unreality) or depersonalization (being detached from oneself),
  • fear of losing control or going crazy,
  • fear of dying,
  • paresthesias (numbness or tingling sensations).
  • chills or hot flushes.

Source : DSM-IV

Separation Anxiety Disorder

Separation anxiety disorder is described in the DSM IV as an inappropriate and excessive anxiety concerning separation from home or from those to whom the individual is attached. This disorder entails three series of symptoms that may take place independently or simultaneously:

  • Distress during separation with repeated signs of complaints showing this anxiety: fears, anger outbreaks, pressing demands for parents not to leave, even a state of panic with somatic signs such as: headaches, nausea, vomiting. Palpitations, dizziness, ...for teenagers. In extreme cases, a desire to die.
  • Cogitation and morbid preoccupations bearing on family integrity and on the child himself: fear of accidents, theft, getting lost...
  • Nostalgia about 'home' and a desire to reunite the family.

This scheme does not vary with gender but instead with age. It is more common amongst children between five and eight and amongst teenagers between thirteen and sixteen. We deem that 4% of children and teenagers suffer from this disorder. Psychiatrists put forward many leads that may explain it: attachment disorder, inhibited personality, affective disorder antecedents in the family, genetic vulnerability, traumatizing or stressful family events. Source: Bailly D. : “La peur de la séparation de l'enfance à l'âge adulte”.

Performance Anxiety Disorder

Most people go through a normal stress before an exam, a presentation in front of a group, a job interview or an evaluation. Others consider success and performance to be so important that this leads to disproportionate stress during such events. This is the burden of people struggling with performance anxiety disorder. Performance anxiety disorder is a state of apprehension, tension or uneasiness put forth by fear of failure.

This can be reflected in many ways:

  • high stress, panic or anxiety crisis before and during an exam, an evaluation, or a presentation,
  • exaggerated perfectionism during periods of studying, at work, in sports or in artistic activities and even in private life,
  • An array of somatic disorders when deadlines are coming (headaches, digestive distress, raise in blood pressure, insomnia, etc.),
  • Fear of undertaking projects about which the outcome is not secured (like university studies or working elsewhere),
  • Fear of being confronted to an eventual failure,
  • Presence of negative and irrational thoughts (I forgot everything, I will fail).

The person suffering from performance anxiety disorder finds the performance more important than the task itself and will attribute more value to success than learning. There is no room for failure. He will tend to explain his failures with his shortcomings and lack of value, and his successes with luck or the simplicity of the task. He enters a vicious cycle: he can never be satisfied with his efforts or have faith in his abilities, hence further being anxious. He will seek to demonstrate his value because he does not think, in the end, he can be loved solely for who he is, and feels that his value uniquely depends on his successes and realization of what he does.

Whence comes performance anxiety disorder?

Performance anxiety disorder, like all personality characteristics, would take its roots during early childhood and during school years. It results from the interaction between the child and the often very demanding parents. The child feeling incompetent before their expectations becomes more anxious and disheartened. He will do everything to deserve their praises and will try at all cost to avoid failure and face their criticisms.

It is highly likely that he will develop poor self-esteem and a profound feeling of incompetence.