Characteristics of anxiety disorders

Anxiety may be understood as the pathological counterpart of normal fear and is manifest by disturbances of mood, as well as of thinking, behaviour, and daily physical activity.

Anxiety disorders include panic disorder, agoraphobia which is the abnormal fear of being helpless in a situation from which escape may be difficult or embarrassing, characterised initially often by panic or anticipatory anxiety and finally by avoidance of open or public places.

Other disorders include generalised anxiety disorder, specific phobia, social phobia, obsessive-compulsive disorder, acute stress disorder and post-traumatic stress disorder.

In addition, there are adjustment disorders with anxious features, anxiety disorders due to general medical conditions, substance-induced anxiety disorders and the residual category of anxiety disorder not otherwise specified.

Anxiety disorders are common all over the world across human cultures while panic disorder and agoraphobia are associated with increased risks of attempted suicide according to the American Psychiatric Association.

As you can see, anxiety disorders are a wide subject, so we will split it up into categories to be covered over a number of articles.

This week we will focus on panic attacks and agoraphobia.

The next feature will focus on the other types of anxiety disorders such as specific phobias.

These are people with a heightened fear of things like spiders, snakes etc beyond the normal.

In the next feature we will also look at the obsessive compulsive disorder.

An example of this group of people are those that check if they have locked their door repeatedly, or need their surroundings to be in the perfect order that they have set otherwise they become uneasy.

The course of anxiety disorders is characterised by relatively early ages of onset, goes on for a long time, relapsing or recurrent episodes of illness, and periods of disability.

A panic attack is a discrete period of intense fear or discomfort that is associated with numerous physical and mental symptoms.

These symptoms include feeling of the heart beating harder and faster, sweating, trembling, shortness of breath, sensations of choking or smothering, chest pain, nausea or vomiting, dizziness or lightheadedness, tingling sensations, and chills or blushing and “hot flashes.”

The attack typically has an abrupt onset, building to maximum intensity within 10 to 15 minutes.

Most people report a fear of dying, “going crazy,” or losing control of emotions or behaviour.

The experiences generally provoke a strong urge to escape or flee the place where the attack begins and, when associated with chest pain or shortness of breath, frequently results in seeking aid from a hospital emergency room or other type of urgent assistance.

Yet an attack rarely lasts longer than 30 minutes, current diagnostic practice specifies that a panic attack must be characterised by at least four of the associated physical and mental symptoms described above.

The panic attack is distinguished from other forms of anxiety by its intensity and its sudden, episodic nature.

Panic attacks may be further characterised by the relationship between the onset of the attack and the presence, or absence of situational factors.

For example, a panic attack may be described as unexpected, situationally bound, or situationally.

There are also attenuated or “limited symptom” forms of panic attacks.

Panic attacks are not always indicative of a mental disorder and up to 10 percent of otherwise healthy people experience isolated panic attacks.

Panic attacks also are not limited to panic disorder.

They commonly occur in the course of social phobia, generalised anxiety disorder, and major depressive disorder.

Panic disorder is diagnosed when a person has experienced at least two unexpected panic attacks and develops persistent worry about having further attacks or changes his or her behaviour to avoid or minimise such attacks.

Whereas the number and severity of the attacks varies widely, the concern and avoidance behaviour are essential features.

The diagnosis is inapplicable when the attacks are presumed to be caused by a drug or medication or a general medical disorder.

As discussed subsequently, approximately one-half of people with panic disorder at some point develop such severe avoidance as to warrant a separate description, panic disorder with agoraphobia.

Panic disorder is about twice as common among women as men. Age of onset is most common between late adolescence and mid-adult life, with onset relatively uncommon past age 50.

The ancient term agoraphobia is translated from Greek as fear of an open marketplace.

Agoraphobia today describes severe and pervasive anxiety about being in situations from which escape might be difficult or avoidance of situations such as being alone outside of the home, travelling in a car, bus, or airplane, or being in a crowded area.

Most people who visit mental health specialists develop agoraphobia after the onset of panic disorder.

Agoraphobia is best understood as an adverse behavioural outcome of repeated panic attacks and the subsequent worry, preoccupation, and avoidance.

Agoraphobia occurs two times more commonly among women than men.

The gender difference may be attributable to social-cultural factors that encourage or permit the greater expression of avoidant coping strategies by women, although other explanations are possible.

There are facilities in Lesotho where psychological/psychiatric conditions are handled such as the Mohlomi psychiatric hospital in Maseru and the psychiatric clinic at Queen Elizabeth II Hospital.

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