Anxiety Disorders

There are many types of anxiety disorders and people can experience more than one type of disorder. Anxiety can severely affect a person’s life and interfere with our ability to cope with work or school. It can hamper our ability to live a full and enjoyable life. Depression commonly occurs alongside anxiety. Cognitive Behavioural Therapy, in particular, has long been demonstrated to be an effective treatment for anxiety problems.

Please remember that the definitions and criteria for diagnoses are constantly evolving and changing (the DSM-IV has been revised several times and is in revision right now). Therefore you will find that not all professionals will agree all the time in regards to certain diagnoses. Thus, we would like to repeat and stress again that it is most important how much YOU are bothered by certain issues, feelings, behaviours and reactions and how much YOU perceive that these interfere in your life. This is where the personal, open and honest discussion with your individual psychologist will be so important and crucial in order to help you to find a way forward in YOUR life (irrespective of diagnosis or not).

Panic Disorder (with or without Agoraphobia)anxiety

Panic Disorder is characterized by sudden attacks of intense fear or anxiety, usually associated with numerous physical symptoms such as heart palpitations, rapid breathing or shortness of breath, blurred vision, dizziness, and racing thoughts. Often these symptoms are thought to be a heart attack by the individual, and many cases are diagnosed in hospital emergency rooms. Sometimes they are accompanied by perceptual changes such as tunnel vision, feeling unreal, or feeling detached from oneself. Individuals with panic disorder may believe that they are having a heart attack or losing their mind and sometimes go to a medical emergency department because of the panic feelings. Very often, once one has had a number of panic episodes, the person develops a fear or preoccupation that they will have another. They can develop a style of scanning for any physical sensations that might suggest a panic is about to occur. It is also not unusual for the panic sufferer to go on to become increasingly avoidant of situations where they have experienced panic attacks. For example, if one has a panic episode on a bus or car, the person may then reduce or even stop taking buses or driving in a car. It is possible that the panic difficulty then becomes associated with agoraphobia.

Agoraphobia

Agoraphobia, like other phobias, is made up of extreme anxiety and fear. Different from other phobias, however, is the generalization which occurs. Agoraphobia is the anxiety about being in places where escape might be difficult or embarrassing or in which help may not be available should a panic attack develop. It can be sub diagnosed as either ‘with’ or ‘without’ panic disorder (see above). Typically situations that invoke anxiety are avoided and in extreme cases, the person may never or rarely leave their home.

Phobias

Phobias are episodes of anxiety that occur in specific situations, such as fear of heights, dogs, enclosed spaces, dentists, bridges, flying, or receiving injections. Symptoms include either extreme anxiety and fear associated with the object or situation and/or avoidance. To be diagnosed, the symptoms must be disruptive to everyday functioning (such as quitting a great job merely because you have to use an elevator). While most people would experience some fear or anxiety in many of those situations, a phobia occurs when the anxiety is excessive and unreasonable. Phobias are severe to the point that the anxiety interferes with the person’s normal routines or functioning. There is a tendency to avoid the situations causing the phobic distress and often the avoidance can interfere with the person’s life.

Obsessive-Compulsive Disorder (OCD)

The key features of OCD include obsessions (persistent, often irrational, and seemingly uncontrollable thoughts) and compulsions (actions which are used to neutralize the obsessions). A good example of this would be an individual who has thoughts that he is dirty, infected, or otherwise unclean which are persistent and uncontrollable. In order to feel better, the hands are washed numerous times throughout the day, gaining temporary relief from the thoughts each time. For these behaviours to constitute OCD, they must be disruptive to everyday functioning (such as compulsive checking before leaving the house making you extremely late for all or most appointments, washing to the point of excessive irritation of your skin, or inability to perform everyday functions like work or school because of the obsessions or compulsions).

Social Phobia

Social phobia manifests in a fear and anxiety related to other people. Specifically, social phobia is about the fear of negative evaluation by others. Those with social phobia worry about being judged or embarrassed in social situations. They therefore tend to avoid interactions with others and especially interactions where they may have to perform or be the centre of attention. The anxiety and distress associated with social phobia is severe enough to interfere with the person’s life. For example the person may avoid social gatherings, dating, attending classes, or applying for particular jobs because of the anxiety.

Generalized Anxiety Disorder (GAD)

Generalized Anxiety Disorder manifests in a generalized tendency to worry about many things. Unlike other anxiety problems, the worrying is not limited to specific situations, people, or physical sensations. Rather, there is a worried style of thinking that tends to be long lasting and be applied to most situations. Accompanying the worrying thinking style is a constant state of muscle tension so that the person usually feels “on edge”.

Post Traumatic Stress Disorder (PTSD)

Posttraumatic Stress Disorder (PTSD) is an anxiety disorder that occurs as a result of exposure to an extreme traumatic stressor involving the threat of death or serious injury. The threat may be experienced directly or may involve witnessing others at risk for death or injury. Some examples of traumatic events are sexual and physical assault, war experiences, imprisonment, car accidents, and natural disasters. PTSD is considered when the symptoms have persisted for at least one month following the traumatic event. If someone experiences significant anxiety symptoms in the month immediately following the trauma they may be suffering from Acute Stress Disorder.

Re-experiencing symptoms can include recurrent thoughts and images, dreams or nightmares, or “flashbacks” where one feels as if they are reliving the event. The person may become apprehensive or even try to avoid sleep because of the fear of having nightmares. Stimuli in the environment such as smells, sights or sounds that resemble some part of the trauma can “trigger” a re-experiencing of the trauma. This re-experiencing is different than a normal memory of some event in that it is much more vivid and intense, “as if” the person was back in the original trauma. Therefore, these re-living experiences are extremely distressing and the person may feel paralyzed and emotionally overwhelmed when they occur. This overwhelming feeling can lead to ongoing efforts at avoiding any reminders of the event.

Avoidance symptoms may manifest in not talking about what happened, not going near where the event happened or even near situations that are similar in some way to the trauma. Often, the person withdraws from others and can become very isolated and secluded, in contrast with previous behaviour. Those close to the person, like family members or friends, are often confused and distressed by these severe changes in the person’s behaviour that seem to occur for no reason. Another aspect of avoidance is emotional numbing, where the person experiences numbness or emotional detachment in situations where they would normally have some emotional reaction. The PTSD sufferer can fluctuate between feeling detached, unemotional and numbed out at times, to being flooded with feelings and thus being very overwhelmed at other times.

Hyper-arousal symptoms may involve sleep difficulties, bouts of irritability, problems with attention and concentration, hyper-vigilance, and an increased startle response. In PTSD, the nervous system seems to be overwhelmed and over-aroused due to the trauma and so relaxation becomes very difficult. This hyper-arousal is often accompanied by scanning for signs of threat and becoming very vigilant to potential dangers in the outer world. Another aspect of the hyper-arousal is that the person becomes very sensitive to loud sounds or bright colours, essentially experiencing “stimulus overload” when there is too much going on at one time.

Adjustment Disorder

Having an Adjustment Disorder involves having significantly more difficult adjustment to a life situation than would normally be expected, considering the circumstances. While it is common to need months and perhaps even years to feel normal again after the loss of a long time spouse, for instance, when this adjustment causes significant problems for an abnormal length of time, it may be considered an Adjustment Disorder. Adjustment Disorder can include having symptoms of anxiety, depression or both.

Separation Anxiety

Children experiencing separation anxiety disorder display significant distress upon separation from the parent or other primary caregiver. Separation anxiety disorder often becomes problematic for families during primary school, although it can also occur in older or younger children. The child appears fearful because he or she thinks something horrible will happen to the child or parent while they are apart. The child’s responses to separation may include crying or becoming angry with the adult in an attempt to manipulate the situation. When thwarted by the adult’s appropriate boundaries, expectations, and structure (the child must attend school, for example), the child’s distress may become displaced into other maladaptive or negative behaviours. The child may begin to exhibit behavioural problems at school or at home when there has been no previous history of such problems. The child may seek out a new, negative peer group in order to gain attention or avoid separation.