The biological imperative for human beings to protect themselves from their external environment has been a constant factor throughout their evolutionary history. As such they have developed an internal mechanism more aptly known as the Fight, fright or flight response to combat the various threats, stressors and challenges of the outside world.
This response usually in the form of fearfulness, anxiety, doubt or uncertainty is a normal response in a healthy individual. However, such feelings when aggravated to pathological levels without the inclusion or requirement of any external stimuli can cause the individuals to become paralyzed and unable to function. If this reaction persists even when the stimuli is removed the individual is said to have an Anxiety Disorder (Simon).
The Diagnostic and Statistical Manual of Mental Disorders states that the term anxiety disorders encompass a wide variety of disorders based on abnormal fears and pathologies. It includes the following types (American Psychiatric Association)
· Generalized anxiety disorder (GAD)
· Panic disorder with and without agoraphobia
· Specific phobia
· Social anxiety disorder also known as Social Phobia
· Obsessive-compulsive disorder (OCD)
· Posttraumatic stress disorder (PTSD)
· Acute stress disorder (ASD)
According to a study conducted by the Anxiety Disorder Association of America an estimated 40 million Americans (18.1%) suffer from one or more of these types of disorders. At 8.7% and 6.8% of the American population affected by Specific phobia and Social anxiety disorder respectively ( Anxiety Disorder Association of America). These two disorders form the most prevalent mental disorders in American society. The pathophysiology of these disorders has not been determined as of yet however it has been surmised that a decrease in serotonin and an increase in noradrenalin levels may be the culprit. While recent studies have also shown that genetic factors may also be a cause, the increased sensitivity to external stimuli remains the primary culprit (Jess Rowney).
Signs and symptoms
Published in 1994 with a text revision in 2000 “The Diagnostic and Statistical Manual of Mental Disorders (DSM)” provides diagnostic criteria for mental disorders. These criteria are the standards used by U.S health professionals to diagnose patients with mental disorders (American Psychiatric Association). The following types of Anxiety disorders are diagnosed using signs and symptoms as detailed by or based on this criteria:
Generalized Anxiety disorder
Found in 6.8% of all Americans ( Anxiety Disorder Association of America). The DSM-IV criteria define an individual to be suffering from Generalized Anxiety Disorder if he experiences pathological anxiety levels for a period up to six months. People in this state are often in distress, cannot sleep properly, are unable to concentrate, feel on edge, are irritable, and lethargic. These symptoms can leave the individual unable to functioning society. This disease can be linked to various psychiatric disorders such as mood disorders, psychosis or even substance abuse (American Psychiatric Association).
Social anxiety disorder also known as Social Phobia
Social Anxiety disorder also known as social phobia is a disorder where an individual fears that being exposed to a social situation with people he/she does not know will leave the individual embarrassed or closely examined. Occurring in 6.8% of the population the disorder is equally common among men and women ( Anxiety Disorder Association of America). The symptoms can range from normal levels of fear manifested as sweating or difficulty in speaking to a panic attack at extreme levels of intensity. The panic attack however will only be caused if the individual is in a public place. The phobia may not only be related a fear to being humiliated in front of people. It may also be due to a specific event in the subject’s history, manifesting when a person has to perform in public (Simon).
Panic Disorders are characterized by sudden periods of intense psychological anxiety or terror which can last up to 15-30 minutes (Simon). The individual will experience various symptoms which include a rapid heart rate, sweaty palms, shortness of breath, nausea, chest pain, etc. These psychological attacks are known as panic attacks. In order to diagnose panic disorder the criteria states that the attacks must be recurrent and unexpected and at least two in number. After the attacks the individual must fear the recurrence of an attack for at least a month. Statistically women are more affected than men ( Anxiety Disorder Association of America). It may occur with other disorders such as post traumatic stress disorder and must be differentiated from using characteristic symptoms. Often time’s agoraphobia (fear of being in an open space) may or may not be associated with the disorder. A patient with agoraphobia will confine themselves to an area where they feel safe such as their home or with another individual they trust (Simon).
Specific Phobias are caused by anxiety of a situation or a specific object usually an animal. This disorder is the most common mental disorder with women twice as likely to be affected as men ( Anxiety Disorder Association of America). The most common types can be fear of various animals, various forms of transport, various activities such as swimming or flying or even various structures such as tunnels or bridges. The criteria require the individual’s recognition of the fear as irrational. Oftentimes the subject will endure it causing intense anxiety to them rather than disclose their condition (Simon).
Obsessive-compulsive disorder (OCD)
In this disorder the individual will experience constant or frequent unwanted thoughts or ideas. Oftentimes these ideas can range from everyday worries such a turning off a stove to unusual fantasies of violence especially towards those closest to them. The disorder manifests in the individual as obsessions or ritualistic acts which he/she must adhere to in order to avoid being anxious. The person may or may not recognize the actions as being compulsive and it may be related to a general medical condition (Simon).
Posttraumatic stress disorder (PTSD)
Post Traumatic Stress Disorder occurs in women more than men with rape being the most common trigger ( Anxiety Disorder Association of America). This disorder is caused by an emotional reaction to a disastrous event which can severely impair the individual’s ability to function. The individual may continuously re-experience the event through images or flashback. They may also avoid reminders of the event including people or places with feelings of dissociation being prevalent. They may also have a heightened state of arousal becoming excited or tense with little or no stimuli (Simon).
Acute stress disorder (ASD)
Used to identify which individuals are in danger of developing PTSD, Acute stress disorder is one in which symptoms of PTSD can occur in a timeline of 2 days to 4 weeks after a traumatic event (Simon). The symptoms of ASD and PTSD are similar however they are differentiated by the diagnostic criteria which states that if the patient presents within 4 weeks of the trauma and the disorder in resolved within 4 weeks the diagnosis is ASD. (American Psychiatric Association)
The approach to treatment for Anxiety disorders though patient specific is usually treated with a combination of psycho and pharmacotherapy. Psychotherapy includes Cognitive-Behavior therapy and exposure therapy. Both treat the root cause of the anxiety that resides in the individual and helps the individual assert a greater sense of control over his fears. In the pharmacotherapy the patient is given various medications including benzodiazepines, GABA analogues and antidepressants. Various studies have argued about the efficacy of either treatment option. However, it cannot be denied that patients respond very well to the treatments given and improvements are noticeable in a very short period of time (Melinda Smith).
Anxiety Disorder Association of America. Statistics and Facts About Anxiety Disorders. 2008. 09 April 2009 <http://www.adaa.org/AboutADAA/PressRoom/Stats&Facts.asp>.
America, Anxiety Disorder Association of. Brief Overview of Anxiety Disorders. 2009. 09 April 2009 <http://www.adaa.org/GettingHelp/Briefoverview.asp>.
American Psychiatric Association. DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS. 2008. 09 April 2009 <http://www.dsmivtr.org/>.
—. DSM-IV-TR. American Psychiatric Publishing, Inc., 2000.
Jess Rowney, Teresa Hermida, Donald Malone. Anxiety Disorders. 2008. 09 April 2009 <http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/psychiatry/anxiety-disorder/>.
Melinda Smith, Robert Segal, Jeanne Segal. Anxiety Attacks and Disorders. June 2008. 09 April 2009 <http://www.helpguide.org/mental/anxiety_types_symptoms_treatment.htm>.
Simon, Harvey. Anxiety disorders – Introduction. 12 December 2007. 09 April 2009 <http://www.umm.edu/patiented/articles/what_anxiety_disorders_000028_1.htm>.