Download Generalized Anxiety Disorder

ANXIETY
Overview
• What is Anxiety?
• What are the different types of anxiety
disorders?
• What are the causes?
• What are the symptoms?
• What are the treatments?
• Professional Resources available.
Definition of Anxiety
• Anxiety is a feeling of apprehension or fear. The
source of this uneasiness is not always known.
• Anxiety disorders are a group of psychiatric
conditions that involve excessive anxiety.
Normal versus Pathologic
Anxiety
• Normal anxiety is adaptive. It is an inborn
response to threat or to the absence of
people or objects that signify safety can
result in cognitive (worry) and somatic
(racing heart, sweating, shaking, freezing,
etc.) symptoms.
• Pathologic anxiety is anxiety that is
excessive, impairs function.
Anxiety Facts
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Most common mental illness in the U.S. with 19 million of the adult
(ages 18-54) U.S. population affected.
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Anxiety disorders cost more than $42 billion a year.
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More than $22 billion are associated with the repeated use of healthcare
services, as those with anxiety disorders seek relief for symptoms that
mimic physical illnesses.
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Anxiety is highly treatable (up to 90% of cases), but only one-third of
those who suffer from it receive treatment
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Depression often accompanies anxiety disorders
2003 Anxiety Disorders Association of America
Types of Anxiety Disorders
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Panic Disorder
Obsessive-Compulsive Disorder
Post-Traumatic Stress Disorder
Phobias
Generalized Anxiety Disorder
Panic Disorder
• The abrupt onset of an episode of intense fear or
discomfort, which peaks in approximately 10
minutes, and includes at least four of the
following symptoms:
• A feeling of danger
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The need to escape
Palpitations
Sweating
Trembling
Shortness of breath
A feeling of choking
Chest pain or discomfort
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Nausea or abdominal discomfort
Dizziness
A sense of things being unreal,
A fear of losing control or "going crazy"
A fear of dying
Chills or hot flushes
Panic Disorder
There are three types of Panic Attacks:
1. Unexpected - the attack "comes without warning sign
and for no discernable reason.
2. Situational - situations in which an individual always
has an attack, for example, upon entering a tunnel.
3. Situationally Predisposed - situations in which an
individual is likely to have a Panic Attack, but does not
always have one. An example of this would be an
individual who sometimes has attacks while driving.
Obsessive-Compulsive Disorder
Characterized by uncontrollable excessive unreasonable
obsessions and compulsions .
• Obsessions are recurring inappropriate thoughts and
cause the sufferer anxiety:
– Thoughts about contamination, for example, when an
individual fears coming into contact with dirt, germs or "unclean"
objects;
– Persistent doubts, for example, whether or not one has turned
off the iron or stove, locked the door .
– Extreme need for orderliness;
– Aggressive thoughts, for example, urge to yell 'fire' in a
crowded theater
Obsessive-Compulsive Disorder
• Compulsions are repetitive behaviors or rituals performed by the OCD
sufferer, performance of these rituals neutralize the anxiety caused by
obsessive thoughts, relief is only temporary.
– Cleaning. Repeatedly washing their hands, showering, or constantly
cleaning their home;
– Checking. Individuals may check several or even hundreds of times to
make sure that stoves are turned off and doors are locked;
– Repeating. Some repeat a name, phrase or action over and over;
– Slowness. Some individuals may take an excessively slow and
methodical approach to daily activities, they may spend hours organizing
and arranging objects;
– Hoarding. unable to throw away useless items, such as old newspapers,
junk mail, even broken appliances
• In order for OCD to be diagnosed, the obsessions and/or compulsions
must take up a considerable amount of the sufferers time, at least one
hour every day, and interfere with normal routines .
Post-Traumatic Stress Disorder
• Exposure to traumas such as a serious accident, a natural
disaster, or criminal assault can result in PTSD.
• When the events of a traumatic experience interferes with
normal functioning, the person may be suffering from PTSD.
• Symptoms of PTSD are:
Reexperiencing the event, which can take the form of intrusive thoughts and
recollections, or recurrent dreams;
– Avoidance behavior in which the sufferer avoids activities, situations,
people,and/or conversations which he/she associates with the trauma;
– A general numbness and loss of interest in surroundings;
– Hypersensitivity, including: inability to sleep, anxious feelings,
hypervigilance, irritability and anger.
Social Phobia/Anxiety
• Social anxiety disorder, also known as social phobia, is an
intense fear of social situations. This fear arises when the
individual believes that they may be judged, scrutinized or
humiliated by others.
• Individuals with the disorder are acutely aware of the
physical signs of their anxiety and fear that others will
notice, judge them, and think poorly of them.
• In extreme cases this intense uneasiness can progress
into a full blown panic attack.
Social Phobia/Anxiety
• Common anxiety provoking social situations include:
– public speaking
– talking with people in authority
– making a phone call or answering the phone
– interviewing
– attending and participating in class
– speaking with strangers
– meeting new people
– eating, drinking, or writing in public
– driving
– shopping
Generalized Anxiety Disorder
• Excessive uncontrollable worry about
everyday things. This constant worry
affects daily functioning and can cause
physical symptoms.
• GAD can occur with other anxiety
disorders, depressive disorders.
Generalized Anxiety Disorder
• The focus of GAD worry can shift, usually
focusing on issues like job, finances, health
of both self and family; but it can also
include more issues such as car repairs
and being late for appointments.
• The intensity, duration and frequency of the
worry are disproportionate to the issue
Specific Disorder Facts
• Generalized Anxiety Disorder
– Women are twice as likely to be afflicted than men.
– Very likely to exist along with other disorders.
• Obsessive Compulsive Disorder
– It is equally common among men and women.
– One third of afflicted adults had their first symptoms in childhood.
• Panic Disorder
– Women are twice as likely to be afflicted than men.
– Occurs with major depression in very high rates.
2003 Anxiety Disorders Association of America
Specific Disorder Facts
• Posttraumatic Stress Disorder
– Women are more likely to be afflicted than men.
• Social Anxiety Disorder
– It is equally common among men and women.
• Specific Phobia affects
– Women are twice as likely to be afflicted as men
2003 Anxiety Disorders Association of America
Anxiety Statistics
Anxiety Disorders
One-Year Prevalence (Adults)
Percent
Population Estimate*
(Millions)
Panic Disorder
1.7
2.4
Obsessive-Compulsive
Disorder
2.3
3.3
Post-Traumatic Stress
Disorder
3.6
5.2
Generalized Anxiety
Disorder
2.8
4.0
* Based on 7/1/98 U.S. Census resident population estimate of 143.3 million, age 18-54
Recent Studies
Freedom From Fear conducted a survey among 410 attendees during
National Anxiety Disorders Screening Day on May 7, 2003. The results :
•An increase in physical aches and pains is directly attributed to anxiety
disorders and depression
•60%) of the respondents with undiagnosed medical conditions said that on
days when they feel anxious or depressed, there is a moderate (41%) to
severe (19%) change in their physical symptoms or aches and pains. These
physical symptoms or aches and pains include backaches (13%),
headaches (14%), digestive pain (11%) and dizziness (8%).
•50% of respondents with diagnosed medical conditions, such as arthritis,
migraines, diabetes, heart and respiratory diseases, reported that on days
when they feel anxious or depressed, there is a moderate (38%) to severe
(12%) change in their physical symptoms or aches and pains.
Common Causes
• There is no one cause for anxiety disorders. Several
factors can play a role
– Genetics
– Brain biochemistry
– Overactive "fight or flight" response
• Can be caused by too much stress
– Life circumstances
– Personality
• People who have low self-esteem and poor coping skills may be more prone
• Certain drugs, can lead to symptoms of anxiety due to
either side effects or withdrawal from the drug.
• In very rare cases, a tumor of the adrenal gland
(pheochromocytoma) may be the cause of anxiety.
ANXIETY DISORDERS
Etiology- Neurotransmitters
• norepinephrine (NE) – concentrated in
locus ceruleus
• serotonin
• dopamine in social phobia and OCD
• interactions – serotonin affects locus
ceruleus (where NE is produced) and may
also influence GABA
Symptoms of Anxiety
Anxiety is an emotion often accompanied by
various physical symptoms, including:
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Twitching or trembling
Muscle tension
Headaches
Sweating
Dry mouth
Difficulty swallowing
Abdominal pain (may be the only symptom of stress
especially in a child)
Additional Symptoms of Anxiety
Sometimes other symptoms accompany
anxiety:
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Dizziness
Rapid or irregular heart rate
Rapid breathing
Diarrhea or frequent need to urinate
Fatigue
Irritability, including loss of your temper
Sleeping difficulties
Decreased concentration
Social Effects of Anxiety
• Depression
– Not as involved with family and friends the way you
used to be
– Lowered quality of relationships
– Low energy
– Lack of motivation to do the things you once looked
forward to doing
• Unable to convey the person that you are
• Fear and avoidance of situations where previous
attacks occurred
Treatments
• Medications (Drug Therapy):
• Behavioral Therapy
• Cognitive Behavioral Therapy
Alternative Treatments
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Acupuncture
Aromatherapy
Breathing Exercises
Exercise
Meditation
Nutrition and Diet Therapy
Vitamins
Medications
• Buspirone: shown to be effective but usually
takes 3-4 weeks, particularly useful in elderly
patients
• Benzodiazepines: include Xanax and Valium, act
rapidly and successfully but can be addictive and
loses effectiveness over time
• Side Effects: dizziness, headaches, nausea,
impaired memory
Behavioral and Cognitive
Therapy
• Teaches patient to react differently to situations and
bodily sensations that trigger anxiety
• Examples: Hyperventilating, writing down list of top fears
and doing one of them once a week, spinning in a chair
until dizzy; after awhile patients learned to cope with the
negative feelings associated with them and replace them
with positive ones
Aromatherapy
• Calming Effect: vanilla, orange blossom, rose,
chamomile, and lavender
• Reducing Stress: Lavender, sandalwood, and
nutmeg
• Uplifting Oils: Bergamot, geranium, juniper, and
lavender
Exercise
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Benefits: symbolic meaning of the activity and
sport, the distraction from worries, mastery of a
sport, biochemical and physiological changes
associated with exercise, symbolic meaning of
the
Helps by expelling negative emotions and
adrenaline out of your body in order to enter a
more relaxed, calm state to deal with issues
and conflicts
Meditation
• Cultivates calmness to create a sense of control
over life
• Practice: Sit quietly in a position comfortable to
you and take a few deep breaths to relax your
muscles, next choose a calming phrase (such as
“om” or that with great significance to you),
silently repeat the word or phrase for 20 minutes
Nutrition and Diet Therapy
• Foods to Eat: whole grains, bananas, asparagus,
garlic, brown rice, green and leafy veggies, soy
products, yogurt
• Foods to Avoid: coffee, alcohol, sugar, strong
spices, highly acidic foods, foods with white flour
• Keep a diary of the foods you eat and your
anxiety attacks; after awhile you may be able to
see a correlation
• East small, frequent meals
Vitamins
• B-Vitamins stabilize the body’s lactate levels
which cause anxiety attacks (B-6, B-1, B-3)
• Calcium (a natural tranquilizer) and magnesium
relax the nervous system; taken in combination
before bed improves sleep
• Vitamin C taken in large doses also has a
tranquilizing effect
• Potassium helps with proper functioning of
adrenal glands
• Zinc has a calming effect on the nervous system
Treatments – Problem-solving training
• What is my problem? What is my goal? What
solutions can I generate to solve the
problem? What might be the consequences of
each solution? Try a solution
• particularly relevant to GAD
• divides problems into manageable units
Self Love
• The most important holistic treatment of all
• Laugh: be able to laugh at yourself and with
others; increases endorphin levels and decreases
stress hormones
• Let go of frustrations
• Do not judge self harshly: don’t expect more from
yourself than you do others
• Accept your faults
The End