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Summary Textbook of psychiatry - Chapter 8 - Anxiety disorders
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Textbook of psychiatryH8 Anxiety disorders
Anxiety is a normal response to an anxiety-provoking stimulus. It is characterized by specific
thoughts and emotions along with consistent physical symptoms and behaviours. It protects
us against accidents and danger.
If a fear stimulus is followed by unusually intense and/or long-lasting anxiety that is out of
proportion, or if anxiety is not due to a fear stimulus, it is referred to as ‘pathological
anxiety’. When this becomes clinically relevant, the patient has an anxiety disorder.
Classification of anxiety disorder (DSM-5):
Panic disorder
Agoraphobia
Specific phobia
Social anxiety disorder
Generalised anxiety disorder
Substance/medication-induced anxiety disorder
Anxiety disorder due to another medical condition
Syndromes:
Anxiety disorders are characterised by anxiety and fear.
Anxiety = thoughts of future threat in the form of brooding and worrying, affectively
with feelings of fear and symptoms of muscle tension, and conatively with avoidance
behaviour.
Fear = the alarm response to real or supposed threat and is associated with thoughts
of immediate threat (cognitive), sympathetic arousal with autonomic symptoms such
as palpitations, sweating and trembling (affective), and fleeing from the situation or
trying to escape from it (conative).
Panic attack = a sudden attack of anxiety, associated with a range of physical symptoms in
which the individual is scared of dying, going crazy or losing control.
Spontaneous panic attacks:
o Develop for no apparent reason
o Last a few dozen minutes
Situational panic attack:
o Triggered by confrontation with a phobic situation familiar to the individual
o Lasts while the individual is confronted with the phobic situation
Avoidance behaviour = behaviour designed to prevent the patient being confronted with
the anxiety situation that he fears.
Passive avoidance = avoiding the phobic situation so that there is no confrontation
with the feared stimulus and no fear response
Active avoidance = safety behaviour
, Panic attack:
10% of the population experiences a panic attack at some time in their lives. This does not
mean all of them develop a panic disorder. Experiencing one or more panic attacks is
however a risk factor for developing panic disorder.
Panic disorder:
When panic attacks keep recurring unexpectedly and the patient is worried about having
another attack. These patients become gradually more worried about having another attack
anticipatory anxiety. It causes them to avoid certain situations they afraid of.
Frequency and severity of the panic attacks differs greatly from one individual to another. It
can also occur during sleep. Some people develop agoraphobic avoidance (avoiding certain
places or situations). Both panic disorders and panic disorders in combination with
agoraphobia are more common in women.
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