Chapter 5"

• Anxiety disorders, obsessive-compulsive spectrum disorders, and trauma-related disorders discussed together due to shared symptomatology
• Fear


  Normal response to threat across species, aimed at survival
• Anxiety


  Future-directed, apprehensive state, often characterized by bodily symptoms and behaviors
• Pathological anxiety involves false alarms or excessive vigilance
• Anxiety disorders exhibit fearful states beyond the actual threat, persisting even when no danger is present
• Examples of anxiety disorders

  • Panic disorder
  • Specific phobias
  • Social phobia
  • Generalised anxiety disorder
  • Obsessive-compulsive spectrum disorders
• Panic attacks


  Represent a true expression of fear, characterized by intense and abrupt fear or discomfort
• Panic attacks can be expected (cued) or unexpected (uncued), occurring across various conditions
• Panic attacks are not considered a disorder but occur across different conditions, including panic disorder
• Biological contributions to anxiety

  • Genetic predisposition
  • Environmental factors activating anxiety genes
  • Neurotransmitter systems like GABA, nor-adrenaline, dopamine, serotonin, and CRF
  • CRF system activating the HPA axis and affecting areas of the brain implicated in anxiety
• Limbic system


  Associated with anxiety, particularly the amygdala
• Behavioral inhibition system (BIS)


  Responds to signals from the brain stem and cortex, leading to anxiety
• Fight/flight system (FFS)


  Activated by abnormalities in serotoninergic transmission, triggers immediate alarm-and-escape responses resembling panic
• Environmental influences can modulate neural systems, affecting susceptibility to anxiety disorders
• Teenage smoking is associated with a significantly increased risk of developing anxiety disorders in adulthood
• Brain imaging reveals hyperresponsiveness of the limbic system and deficient regulatory functions of the cortex in anxiety disorders
• Physiological triggers of panic

  • Increased carbon dioxide levels
  • Myocardial infarction
  • Pulmonary embolism
  • Certain medications
  • Hyperthyroidism
  • Phaeochromocytoma
  • Chronic diseases
  • Substance abuse
• Exclusion of physical conditions mimicking panic is crucial in diagnosis and management
• Freud's theory of anxiety


  Anxiety stems from reactivation of infantile fearful situations
• Behavioral theories of anxiety

  Anxiety results from classical conditioning or modeling
• Integrated model of anxiety


  Considers various psychological factors contributing to anxiety
• Childhood experiences and sense of control

  Positive and predictable interactions with parents foster a sense of control, while overprotective parenting may hinder the development of coping skills
• Socioeconomic difficulties, cultural factors, and adverse social environments contribute to anxiety
• Stressful life events, particularly in disadvantaged populations, exacerbate vulnerability to anxiety disorders
• Cultural influence on anxiety expression

  Cultural factors influence how anxiety is experienced, interpreted, and managed
• Triple vulnerability theory


  Biological vulnerability, psychological vulnerability, and specific psychological vulnerability interact to predispose individuals to anxiety
• Anxiety increases the likelihood of panic


  Suggesting an evolutionary response to potential threats
• Panic runs in families and may have a separate genetic component from anxiety
• Anxiety and related disorders often coexist with each other, as well as with depression
• Major depression is the most common additional diagnosis, significantly impacting recovery and relapse rates
• Anxiety disorders frequently co-occur with physical conditions such as thyroid disease, respiratory disease, and cardiovascular disorders
• Comorbid anxiety and physical diseases lead to greater morbidity and lower quality of life
• Individuals with anxiety disorders, particularly panic disorder (PD) and post-traumatic stress disorder (PTSD), have an increased risk of suicidal ideation and attempts
• Comorbid anxiety disorders with depression further elevate the risk of suicide
• Generalized Anxiety Disorder (GAD)


  Characterized by excessive worrying about minor events, difficulty in controlling worry, and physical symptoms such as muscle tension and fatigue
• GAD often coexists with other anxiety disorders and is associated with significant impairment in daily functioning
• DSM-5 criteria for GAD


  Persistent and uncontrollable worry for at least six months, with physical symptoms including muscle tension, headaches, fatigue, and difficulty sleeping
• GAD affects individuals of all ages and commonly involves worrying about various aspects of life, including health, family, work, and academic performance
• Approximately 3.1% of the population experiences GAD in any given year, while 5.7% will experience it at some point in their lifetime
• In adolescents (ages 13–17), the one-year prevalence of GAD is around 1.1%