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Anxiety Disorders
Nursing 201
Introduction
– Anxiety provides the motivation for
achievement, a necessary force for survival.
– Anxiety is often used interchangeably with the
word stress; however, they are not the same.
– Anxiety may be differentiated from fear in that
the former is an emotional process, whereas
fear is cognitive.
Epidemiological statistics
– Anxiety disorders are the most common of all psychiatric
illnesses
– More common in women than men
– Minority children and children from low socioeconomic
environments at risk
– A familial predisposition probably exists
• How much is too much?
– When anxiety is out of proportion to the situation that is
creating it.
– When anxiety interferes with social, occupational, or other
important
areas of functioning.
Assessment
Panic disorder
• Generalized anxiety disorder
• Panic disorder with agoraphobia
Predisposing Factors
• Psychodynamic theory
• Cognitive Theory
• Biological aspects
• Transactional Model of Stress
Adaptation
Nursing Diagnosis
Outcomes
Planning/Implementation
Phobias
Assessment
• Agoraphobia without history of panic disorder
– Fear of being in places or situations from which escape might be
difficult or in which help might not be available if a limitedsymptom attack or panic-like symptoms should occur
• Social phobia
– Excessive fear of situations in which the affected person might do
something embarrassing or be evaluated negatively by other
• Specific phobia
– Marked, persistent, and excessive or unreasonable fear when in the
presence of, or when anticipating an encounter with, a specific
object or situation, Animal type, Natural environment type, Bloodinjection-injury type, Situational type
Predisposing Factors
Nursing Diagnosis
Outcomes
Planning/Implementation
Evaluation
Obsessive-Compulsive Disorder
(OCD)
Assessment
• Obsessions: Unwanted, intrusive, persistent
ideas, thoughts, impulses, or images that
cause marked anxiety or distress
• Compulsions: Unwanted repetitive
behavior patterns or mental acts that are
intended to reduce anxiety, not to provide
pleasure or gratification
Predisposing Factors
Nursing Diagnosis
Outcomes
Planning/Implementation
Post-traumatic Stress Disorder
(PTSD)
– Development of characteristic symptoms following
exposure to an extreme traumatic stressor involving a
personal threat to physical integrity or to the physical
integrity of others
– Characteristic symptoms include reexperiencing the
traumatic event, a sustained high level of anxiety or
arousal, or a general numbing of responsiveness.
Intrusive recollections or nightmares of the event are
common.
• Psychosocial theory
– The traumatic experience
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Severity and duration of the stressor
Extent of anticipatory preparation before onset
Exposure to death
Numbers affected by life threat
Extent of control over recurrence
Location where trauma was experienced
– The individual
• Degree of ego-strength
• Effectiveness of coping resources
• Presence of preexisting psychopathology
– Outcomes of previous experiences with stress/trauma
– Behavioral tendencies
– Current psychosocial developmental stage
– Demographic factors
– The recovery environment
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Availability of social supports
Cohesiveness and protectiveness of family and friends
Attitudes of society regarding the experience
Cultural and subcultural influences
• Learning theory
– Negative reinforcement as behavior that leads to a reduction in an
aversive experience, thereby reinforcing and resulting in repetition
of the behavior
– Avoidance behaviors
– Psychic numbing
• Cognitive theory
– A person is vulnerable to post-traumatic stress disorder when
fundamental beliefs are invalidated by experiencing trauma
that cannot be comprehended and when a sense of helplessness and
hopelessness prevails.
• Biological aspects
– It has been suggested that a person who has experienced
previous trauma is more likely to develop symptoms after a
stressful life event.
– Disregulation of the opioid, glutamatergic, noradrenergic,
serotonergic, and neuroendocrine pathways may be involved
in the pathophysiology of PTSD.
• Transactional Model of Stress Adaptation
– The etiology of PTSD is most likely influenced by multiple
factors
Nursing Diagnosis
Outcomes
Planning/Implementation
Client/Family Education
Treatment Modalities
• Psychopharmacology
– PTSD
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Antidepressants
• Anxiolytics
• Antihypertensives
• Others