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Classification and description of Anxiety Disorders

Classification and description of Anxiety Disorders

Clinically the anguishIt is fear without knowing what. Normal fear is a reaction with psychological and bodily components. Fear and anguish are part of the normal response of the individual, with reactions necessary for survival.

As in all neurosis, a reaction that is originally normal and useful for survival is distorted by increasing both in intensity and frequency that, instead of being a helpful defensive mechanism, it becomes a source of suffering and disability. If this disproportionate response becomes chronic we are facing an anxiety neurosis or anguish neurosis.

Anxiety neuroses usually predominate in the female sex and their age of onset is between 20 and 40 years. The figures are between 15 and 25% probability of incidence of anxiety disorders throughout life.

Anguish can appear in two ways: in a permanent state of anxiety or in bursts of anguish, separated by intervals of apparent normality.

Content

  • 1 Crisis of anguish
  • 2 Generalized anxiety
  • 3 phobias
  • 4 Post-traumatic Stress Disorders (PTSD)
  • 5 Acute Stress Disorder
  • 6 Substance-induced anxiety disorder
  • 7 Obsessive Compulsive Disorder (OCD)
  • 8 Treatment of anxiety disorders

Crisis of anguish

It consists of the sudden appearance of anxiety at its maximum intensity. The typical crisis usually occurs suddenly, without previous warning symptoms. It is not uncommon to be triggered during sleep, waking the patient with the symptoms in full intensity.

These crises are lived by the patient as a sign of imminent death, the intensity of suffering is equivalent to that of someone who notices that they will kill him. It is accompanied by bodily symptoms of panic: tachycardia, palpitations, rapid breathing, choking or shortness of breath, nausea or abdominal discomfort, dizziness, fainting or lightheadedness, paleness, cold hands and feet, feeling of precordial oppression that occasionally reaches being chest pain, sweating, paraesthesia (feeling numb or tingling), fear of losing control or "going crazy" and fear of dying.

The crisis usually lasts a few minutes, but may persist for hours. The feeling of danger to life is so alive during the crisis of anguish (especially due to chest pain), that the patient goes to several doctors not being calm if he is told that he has nothing of the heart, because it does not seem possible that symptoms as alarming as his own do not have a serious organic cause.

Generalized anxiety

They are permanent, but milder, manifestations of anxiety. The symptoms do not appear so acutely, they produce a feeling of generalized discomfort and the symptoms are usually: palpitations, paleness, urination, diarrhea, sweating, tremor, difficulty concentrating, speaking or even breathing. The frequency is that anxiety crises are combined with the generalized anxious state and that the patient among their crises is not normal, if not distressed before any stimulus (go by subway, get away from home, go to an interview, etc).

For the diagnosis of this disorder, the first thing that should be observed is that the subject has been suffering most of the days, for not less than six months, of excessive anxiety and over-concern in relation to a wide range of situations and activities.

In turn, the individual must have had difficulty controlling this state of constant worry and apprehension, accompanied by at least three other symptoms such as restlessness, premature fatigue, deconcentration, irritability, muscle tension and sleep disorders.

Phobias

They are anxious responses above normal when faced with a specific stimulus: traveling by plane, being in closed places, etc. here are the agoraphobias, the simple phobias and social phobias.

  • Agoraphobia: It is a very common type of anxiety disorder. It may be fear of being in open spaces, or fear of being in spaces or situations where escape is difficult because it implies a commitment. As the person is afraid to suffer the crisis and not be able to be helped, he ends up being confined in his home without leaving. The situations that are most commonly avoided are being away from home, in an elevator, in an airplane, car, in a closed place, in the middle of a crowd or in open spaces. Some subjects may face these situations but at the expense of suffering severe anxieties, fear or equivalent symptoms.
  • Simple phobias: It is a specific fear of something, spiders (arachnophobia), water (hydrophobia), fire (pyrophobia), blood (hematophobia), travel by plane, etc. Specific phobia is more frequent than social phobia and can develop after having witnessed or suffered a traumatic event.
    The specific phobia is characterized by a marked and persistent irrational and excessive fear, caused by the presence or anticipation of specific objects or situations. Being in front of the phobic stimulus causes an anxious response in the subject. Most often this stimulus is avoided, but if it is experienced, an episode of intense anxiety will be triggered.
  • Social phobias: It is the fear on the part of the subject to be exposed under the observation of others. Social phobia typically appears in adolescence, and there may be a childhood history of shyness or social inhibition. The appearance of social phobia may arise abruptly after experiencing a humiliating or stressful situation, or it may appear slowly.

A subject suffering from social phobia, when facing an event in public, whether speaking in front of a group of people, eating, drinking or writing, experiences a constant concern about the possibility that others perceive them as crazy, anxious , weak, also often believes that the situation can be embarrassing. Faced with social situations, redness is very common.

Post-traumatic Stress Disorders (PTSD)

The PTSD It occurs when the person has really suffered a traumatic event in which his life has been in danger, and although it was an isolated episode, the experience returns in the form of nightmares and fears. Also included as traumatic is the fact of having learned of a horrific unexpected situation that a significant person has suffered. These traumas include natural catastrophes, rapes, kidnapping, combat experiences, torture, diagnoses of fatal diseases and serious accidents. Sometimes drug addictions are established to forget.

There are people who face very serious traumatic experiences that do not present this type of disorder and some people who experience less catastrophic events but due to the subjective meaning of the event, suffer from a post-traumatic stress disorder.

This disorder has an acute onset. It can appear at any age, even during childhood. It is diagnosed when a person develops a certain symptomatology, after having experienced a situation that could be categorized as traumatic.

The symptomatic response to the traumatic event is the intense reexperimentation of it through memories, nightmares and psychological distress intense when exposed to similar or associated stimuli. There may be an inability to remember important aspects of trauma, reduced interest in previously pleasurable activities, detachment, feeling of a future of desolation and restriction of affective life.

A criterion for the diagnosis of this disorder is the duration of these symptoms, since it must be prolonged for more than a month, otherwise it would be an acute stress disorder.

Acute stress disorder

As in Post-traumatic Stress Disorder, in Acute Stress Disorder, the individual experiences the traumatic event that happened before, responding with horror, intense fear and hopelessness.

The most common symptoms are the reduction of the expression of feelings, the reduction of consciousness, derealization (feeling that the environment is unreal or strange), depersonalization (feeling of unreality or lack of familiarity with oneself) and dissociative amnesia (inability to remember the traumatic event). To make the diagnosis, the alterations must last between at least two days and not more than four weeks.

People with this disorder may have feelings of despair, many feel guilty for having survived the event, or for not providing enough help to others who were there. Sometimes they even feel responsible for the consequences of what happened.

There is a high degree of probability that subjects with this disorder suffer from Post-traumatic Stress Disorder.

The treatment of this disorder is similar to that used for posttraumatic stress, but in turn the dissociative symptoms should be treated. A combination between the psychopharmacotherapy, psychotherapy and psychoeducation. The support groups for the patient and the family serve to identify with others who went through the same situation and not feel isolated, in addition to receiving additional support.

Substance-induced anxiety disorder

It is characterized by the presence of anxious symptoms secondary to the direct physiological effects of a substance (drug or medication).

Depending on the nature of the substance, it may include crises of distress, phobias, obsessions and / or compulsions, both during intoxication and during periods of withdrawal. The symptoms must persist more than one month after the acute withdrawal period or intoxication to diagnose this disorder, or they must be clearly excessive depending on the type and amount of substance ingested.

The anxious symptomatology produced by withdrawal or intoxication of the substances is usually transient and remits after the substance is metabolized, restoring the physiological balance of the organism.

The most common substances that produce the appearance of an anxiety disorder They are: alcohol, amphetamines and derivatives, hallucinogens, caffeine, cannabis, cocaine, phencyclidine and derivatives, inhalants, and other unknown substances. In the case of withdrawal, the substances that can develop a similar picture are alcohol, cocaine, sedatives, hypnotics and anxiolytics. It would also include volatile substances such as gasoline, paints, insecticides, etc.

Obsessive Compulsive Disorder (OCD)

The main symptomatology of this disorder it is a feeling of subjective compulsion, to which resistance is offered, to persist in an idea, perform some action, remember an experience or ruminate about an abstract matter. Thoughts are not desired, and are perceived by the patient as inappropriate and meaningless. The obsessive idea is recognized as alien to the personality, but coming from within itself. Obsessive actions can acquire an almost ritualistic character in order to relieve anxiety, for example, washing your hands. The temptations to discard thoughts that are not accepted lead to a marked internal struggle.

Obsessions are recurring thoughts, ideas, feelings or feelings that cause great anxietyThey are intrusive and people qualify them as outside their control, although they know they are a product of their mind.

Compulsions are behaviors or mental acts of a recurring, conscious and stereotyped nature, which are carried out in order to calm or prevent anxiety, never for pleasure or gratification. When the individual resists compulsion, his anxiety intensifies. The most common compulsions are those related to washing or cleaning tasks, checks, certainty requirements, the order of objects and repetitive acts.

This disorder can be very disturbing, due to the large amount of time that obsessions can and compulsions can cause in the normal routines of the subject, at work or social relationships. For this reason they usually cause a deterioration of their cognitive activities where they need the use of concentration, such as reading or calculation.

Some subjects end up avoiding or moving away from objects or situations that cause them obsessions and compulsions, being able to generalize this avoidant behavior, seriously limiting the overall activity of the individual. Hypochondriac concerns are frequent and are revealed in repeated medical visits.

Treatment of anxiety disorders

During distress crises they can be administered Anxiolytic or tranquilizing medications to provide symptomatic relief to the patient. Subsequently, the treatment must be psychotherapeutic with cognitive behavioral techniques such as relaxation, exposure to distressing stimuli, systematic desensibillization, biofeedback, assertive training, etc. Relaxation techniques and breathing training are essential for relief from crises, fear and anticipatory anxiety.

Family therapy and group therapy are also recommended to help affected people and their families to adapt to the psychosocial difficulties that this disorder entails.

The combination of these types of treatments helps 70 to 90% of the people affected. A significant improvement can be seen 6 to 8 weeks after starting treatment.

References

National Institute of Mental Health (NIMH). (1997) "Anxiety Disorders". Psychiatry. Com - Vol 1. No. 1 September 1997

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