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Generalised Anxiety Disorder, Panic Disorder, Phobias, OCD and PTSD The are numerous disorders described in the DSM. One category are anxiety disorders. ANXIETY is a state of emotinal arousal associated with feelings of apprehension, worry or uneasiness that something is wrong or something bad is about to happen. Three basic elements of anxiety are: 1. Feelings of tension, apprehension, dread and an expectation of not being able to cope. 2. Behavioural responses such as avoidance of a feared situation. 3. Phsiological responses including muscle tension, increased heart rate and bllod pressure, rapid breathing, dry mouth, nausea, diarrhoea and dizziness. Anxiety is a normal part of our lives. It is an adaptive response. It can prompt us to have a medical check-up and study hard for an exam. Anxiety should not become so severe that is imparis performance. It can become a source of extreme distress and can indicate an anxiety disorder. These are the most frequently experienced and diagnosed of all the mental disorders. Anxiety disorders are characterised by chronic feelings of tension, distress, nervousness and apprehension or fear about the future, with a negative effect. It interferes with their ability to function normally in everyday life. 5 Types of Anxiety Disorders Generalised anxiety disorder Panic disorder Phobias Obsessive Compulsive Disorder (OCD) Post Traumatic Stress Disorder (PTSD) 28 year old Cassandra has been worried about her health, job and marriage. She has always worried about things, but over the past 8 months she has become nervous and tense. This heightened anxiety began after an argument with a co-worker whom she believe to be taking credit for her work. Since the argument, she has been unable to stand up to this person. She worries constantly about the quality of her work and this if she makes a mistake, she will lose her job. She has began to lie awake at night, preoccupied with thoughts about how to deal with her difficult work colleague, the future, how she will get another job if she is sacked, and whether her husband is faithful. She has visited her doctor a number of times in the past 8 months for various problems including severe stomach cramps, diarrhoea , chest pain and shortness of breath, which she felt sure were signs of a serious physical illness. The doctor has repeatedly assured her that she does not have any major physical illness. People with GAD worry constantly about the possibility of problems occurring, such as something happening to themselves or their family, financial difficulties, health problems, or concerns with work or personal relationships. They experience extreme symptoms frequently, their worrying is irrational and are often unable to control their anxiety. Affects women more than men at a 2:1 ratio. 3 main forms of treatment: Cognitive behaviour therapy (CBT) Relaxation therapy Medication CBT aims to change the irrational and unrealistic beliefs, attitudes and expectations people often have. They are taught to change their negative thoughts into more rational thoughts. Relaxation skills are also taught to keep their anxiety under control. Panic disorder involves recurring, unexpected attacks of anxiety in situations where people would not normally be afraid. People who suffer from panic attacks feel fear, apprehension or even terror. A diagnosis of panic disorder involves the experience of dysfunctional changes in thinking and behaviour as a result of the attacks for a period of a month or more. Panic disorder is often accompanied by agoraphobia. It is the fear of being in a place from which it may be difficult to escape or where it may be difficult to get help in the event of a panic attack. Agoraphobics are often afraid to leave their homes and travel to public places. It can become so severe that they are afraid to walk outside the door of their home for fear of a panic attack. Medication Antidepressants prescribed by psychiatrists can reduce or stop panic attacks, but not treat the anxiety. CBT Relaxation techniques Slow breathing technique Phobias are excessive or unreasonable fears directed to a particular object, situation or event, which cause significant distress or interfere with everyday functioning. Most phobias can be kept to a manageable level as long as the course of their phobia is avoided. Many people with phobias are aware that their fears are excessive and unreasonable, but may not know how they started. Most phobias are classified under the DSM category called specific phobias. A specific phobia is an extreme and persistent fear of a specific object or situation. According to the DSM, a pattern of thoughts, feelings and behaviours will be classified as a specific phobia only if the excessive and unreasonable fear of the specific object or situation has persisted for at least 6 months. DSM identifies 2 other categories: Social Phobia Agoraphobia Social phobia is an irrational fear of social or performance situations in which embarrassment may occur. Most people do not seek treatment for their phobias, as they learn to avoid the object or situation that triggers their anxiety. However, some phobias require treatment as the phobia interferes with their everyday life. Specific phobias can be treated effectively with CBT. Systematic desensitisation A phobic person is taught to replace their fear response to the specific stimulus that triggers that fear response with a relaxed response. Modelling The client observes while the mental health professional confronts and successfully deals with the feared object or situation. PTSD is a severe psychological reaction to an intensely traumatic event that was harmful or life threatening either to the person or to others. It lasts at least 1 month after the event. Some events are: assault, rape, armed robbery, etc. The DSM describes 3 main groups of symptoms associated with PTSD Intrusive symptoms Avoidance symptoms Hyperarousal symptoms Involve continual intrusion of the traumatic event into the thoughts of the PTSD sufferer, as they relive the traumatic event in their mind. Distressing memories Distressing dreams Acting or feeling as if the traumatic event is happening again Intense psychological distress Physiological reactions such as sweating and heart racing when reminded of the event. Involves attempts to block out unpleasant memories and feelings associated with the trauma. Symptoms include: Efforts to avoid thoughts, feelings or conversations Efforts to avoid activities, places, people Inability to recall an important aspect of the event Feelings of detachment from others PTSD sufferers can also feel like they are constantly in danger. Symptoms include: Difficulty falling or staying asleep Irritability or outbursts of anger Difficulty concentrating Hypervigilance for signs of danger CBT Relaxation training SBT Stress management strategies Rap groups: Meeting with others to share thoughts feelings & experiences to develop a greater understanding of one’s personal responses and to offer support to each other.