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Chapter 09Anxiety Disorders
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Anxiety Defined
• Vague, uneasy, emotional feeling normally experienced in
response to perceived threat or danger
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Anxiety as a Symptom
• Free-floating anxiety
• Thoughts, feelings, behaviors
• Automatic relief behaviors
• Unrelieved anxiety over time leads to disorder
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Anxiety Disorders
• Uncontrolled, overwhelming anxiety
• Impaired functioning
– Personal
– Social
– Work
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Panic Disorder
• Panic attack
– Rapid heartbeat
– Increased perspiration
– Chilling/numbness
– Nausea
– Feeling of suffocation
– Chest pain/fear of heart attack
– Fear of being out of control
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Agoraphobia
• Avoid places or situations that trigger panic attack
• Restrict activities to avoid recurrence of symptoms
• Often homebound or restricted to home environment
• Unemployment or school dropout common
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Phobias
• Specific phobia
– Excessive, persistent fear of object or situation
– Anxiety with contact
• Social phobia, also called social anxiety disorder
– Excessive fear of social situations in which
embarrassment is possible
– Discomfort being watched or at risk of being judged
by others
– Anticipatory anxiety
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Obsessive-Compulsive Disorder
• Obsession
– Recurrent, persistent, unwanted thoughts or images
causing intense anxiety
• Compulsion
– Repetitive behavior engaged in to reduce high level
of anxiety
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Posttraumatic Stress Disorder (PTSD)
• Response to a situation involving actual death or threat
of injury
• Intense feeling or fear following an event
• Mental reruns of an event
• Emotional numbness
• Avoidance of people and places associated with an event
• Insomnia, inability to concentrate, impaired social or
work functioning
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Generalized Anxiety Disorder
• Chronic worry/anxiety
• Negative self-talk
• Fatigue
• Difficulty falling/staying asleep
• Tension
• Anticipating the “worst”
• Irritability, headaches, tremors
• Physical symptoms
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Treatment of Anxiety Disorders
• Focus is to reduce the anxiety level
• Medications
– Antianxiety drugs
– Greatest success in combination with psychotherapy
• Psychotherapy
– Cognitive-behavioral therapy
– Anxiety support groups
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process Applied
• Take steps to lower the anxiety level; encourage the
client’s trust
• Assessment
– Current feelings
– What happened immediately prior to the onset of
symptoms
– Client’s perspective on the situation
– Thought processes
– Communication ability, thought blocking
– Affect, expression, nonverbal behaviors
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Nursing Process Applied (Cont.)
• Nursing diagnoses
• Expected outcomes
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process Applied (Cont.)
• Interventions
– Consider how your own anxiety may affect nursing
care
– Should be timely, client centered, and realistic (small
steps)
– Help the client try more adaptive coping strategies
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Nursing Process Applied (Cont.)
• Evaluation
– Client’s ability to recognize and deal with the anxietyproducing factors
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Question
• Tell whether the following statement is true or false.
The obsession aspect of obsessive-compulsive disorder
refers to repetitive behavior.
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
• False
• Rationale: Obsession refers to recurrent, persistent,
unwanted thoughts or images that cause intense anxiety.
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• Which disorder is characterized by mental reruns of an
event, emotional numbness, and/or avoidance of people
and places associated with the event?
A. Agoraphobia
B. Obsessive-compulsive disorder
C. Generalized anxiety disorder
D. Posttraumatic stress disorder
E. Panic disorder
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Answer
• D. Posttraumatic stress disorder
• Rationale: A person with posttraumatic stress disorder
experiences mental reruns, numbness, and avoidance of
people and places associated with an event; the disorder
usually occurs following a situation that involves a death
or a threat of a severe injury.
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• Tell whether the following statement is true or false.
A person suffering from agoraphobia is often homebound.
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
• True
• Rationale: A person with agoraphobia often chooses to
remain in familiar home surroundings.
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins