Sunday, 10 February 2013
Research - Anxiety and its disorders
Anxiety (also called angst or worry) is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. It is the displeasing feeling of fear and concern. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness, and dread. It is also associated with feelings of restlessness, fatigue, concentration problems, and muscle tension. However, anxiety should not be confused with fear, which is more of a dreaded feeling about something which appears intimidating and can overcome an individual. Anxiety is considered to be a normal reaction to a stressor. It may help an individual to deal with a demanding situation by prompting them to cope with it. However, when anxiety becomes overwhelming, it may fall under the classification of an anxiety disorder. Anxiety can be confused with fear. However, fear is concrete, (a real danger) whereas anxiety is the paranoia of something out there that seems menacing but may not be menacing, and, indeed, may not even be out there.
Anxiety is a generalized mood that can occur without an identifiable triggering stimulus. As such, it is distinguished from fear, which is an appropriate cognitive and emotional response to a perceived threat. Additionally, fear is related to the specific behaviors of escape and avoidance, whereas anxiety is related to situations perceived as uncontrollable or unavoidable. Another view defines anxiety as "a future-oriented mood state in which one is ready or prepared to attempt to cope with upcoming negative events," suggesting that it is a distinction between future and present dangers which divides anxiety and fear. In a 2011 review of the literature, fear and anxiety were said to be differentiated in four domains: duration of emotional experience, temporal focus, specificity of the threat, and motivated direction. Fear is defined as short lived, present focused, geared towards a specific threat, and facilitating escape from threat; while anxiety is defined as long acting, future focused, broadly focused towards a diffuse threat, and promoting caution while approaching a potential threat. While most everyone has an experience with anxiety at some point in their lives, as it is a common reaction to real or perceived threats of all kinds, most do not develop long-term problems with anxiety. When someone does develop chronic or severe problems with anxiety, such problems are usually classified as being one or more of the specific types of Anxiety Disorders.
Anxiety takes several forms: phobia, social anxiety, obsessive-compulsive, and post-traumatic stress. The physical effects of anxiety may include heart palpitations, tachycardia, muscle weakness and tension, fatigue, nausea, chest pain, shortness of breath, headache, stomach aches, or tension headaches. As the body prepares to deal with a threat, blood pressure, heart rate, perspiration, blood flow to the major muscle groups are increased, while immune and digestive functions are inhibited (the fight or flight response). External signs of anxiety may include pallor, sweating, trembling, and pupillary dilation. For someone who suffers anxiety this can lead to a panic attack. Sir Aubrey Lewis even suggests that "anxiety" could be defined as agony, dread, terror, or even apprehension.
Although panic attacks are not experienced by every person who suffers from anxiety, they are a common symptom. Panic attacks usually come without warning and although the fear is generally irrational, the subjective perception of danger is very real. A person experiencing a panic attack will often feel as if he or she is about to die or lose consciousness. Between panic attacks, people with panic disorder tend to suffer from anticipated anxiety- a fear of having a panic attack may lead to the development of phobias. Anxiety is the most common mental illness in America as approximately 40 million adults are affected by it. Not only is anxiety common in adults, but it has also been found to be more common in females rather than males.
The emotional effects of anxiety may include "feelings of apprehension or dread, trouble concentrating, feeling tense or jumpy, anticipating the worst, irritability, restlessness, watching (and waiting) for signs (and occurrences) of danger, and, feeling like your mind's gone blank”as well as "nightmares/bad dreams, obsessions about sensations, deja vu, a trapped in your mind feeling, and feeling like everything is scary.
The cognitive effects of anxiety may include thoughts about suspected dangers, such as fear of dying. "You may... fear that the chest pains are a deadly heart attack or that the shooting pains in your head are the result of a tumor or aneurysm. You feel an intense fear when you think of dying, or you may think of it more often than normal, or can’t get it out of your mind."
The behavioral effects of anxiety may include withdrawal from situations which have provoked anxiety in the past.Anxiety can also be experienced in ways which include changes in sleeping patterns, nervous habits, and increased motor tension like foot tapping.
The symptoms of anxiety include excessive and ongoing worry and tension, an unrealistic view of problems, restlessness or a feeling of being "edgy", irritability, muscle tension, headaches,sweating, difficulty concentrating, nausea, the need to go to the bathroom frequently, tiredness, trouble falling or staying asleep, trembling, and being easily startled causes.
An evolutionary psychology explanation is that increased anxiety serves the purpose of increased vigilance regarding potential threats in the environment as well as increased tendency to take proactive actions regarding such possible threats. This may cause false positive reactions but an individual suffering from anxiety may also avoid real threats. This may explain why anxious people are less likely to die due to accidents.
The psychologist David H. Barlow of Boston University conducted a study that showed three common characteristics of people suffering from chronic anxiety, which he characterized as "a generalized biological vulnerability," "a generalized psychological vulnerability," and "a specific psychological vulnerability." While chemical issues in the brain that result in anxiety (especially resulting from genetics) are well documented, this study highlights an additional environmental factor that may result from being raised by parents suffering from chronic anxiety.
Other contextual factors that are thought to contribute to anxiety include gender socialization and learning experiences. In particular, learning mastery (the degree to which people perceive their lives to be under their own control) and instrumentality, which includes such traits as self-confidence, independence, and competitiveness fully mediate the relation between gender and anxiety. That is, though gender differences in anxiety exist, with higher levels of anxiety in women compared to men, gender socialization and learning mastery explain these gender differences.Research has demonstrated the ways in which facial prominence in photographic images differs between men and women. More specifically, in official online photographs of politicians around the world, women's faces are less prominent than men's. Interestingly enough, the difference in these images actually tended to be greater in cultures with greater institutional gender equality.
Anxiety disorder is a blanket term covering several different forms of a type of common psychiatric disorder characterized by excessive rumination, worrying, uneasiness, apprehension and fear about future uncertainties either based on real or imagined events, which may affect both physical and psychological health. There are numerous psychiatric and medical syndromes which may mimic the symptoms of an anxiety disorder such as hyperthyroidism which is frequently misdiagnosed as generalized anxiety disorder.
True anxiety disorders seem to have a variety of psychosocial causes; and may involve a genetic predisposition. Individuals diagnosed with an anxiety disorder may be classified in one of two categories; based on whether they experience continuous or episodic symptoms.
Current psychiatric diagnostic criteria recognize a wide variety of anxiety disorders. Recent surveys have found that as many as 18% of Americans and 14% of Europeans may be affected by one or more of them.
The term anxiety covers four aspects of experiences an individual may have: mental apprehension, physical tension, physical symptoms and dissociative anxiety. Anxiety disorder is divided into generalized anxiety disorder, phobic disorder, and panic disorder; each has its own characteristics and symptoms and they require different treatment (Gelder et al. 2005). The emotions present in anxiety disorders range from simple nervousness to bouts of terror (Barker 2003).
Standardized screening clinical questionnaires such as the Taylor Manifest Anxiety Scale or the Zung Self-Rating Anxiety Scale can be used to detect anxiety symptoms, and suggest the need for a formal diagnostic assessment of anxiety disorder.
Generalized anxiety disorder
Generalized anxiety disorder (GAD) is a common chronic disorder characterized by long-lasting anxiety that is not focused on any one object or situation. Those suffering from generalized anxiety experience non-specific persistent fear and worry and become overly concerned with everyday matters. Generalized anxiety disorder is the most common anxiety disorder to affect older adults.Anxiety can be a symptom of a medical or substance abuse problem, and medical professionals must be aware of this. A diagnosis of GAD is made when a person has been excessively worried about an everyday problem for six months or more. A person may find they have problems making daily decisions and remembering commitments as a result of lack of concentration/preoccupation with worry. Appearance looks strained, with increased sweating from the hands, feet and axillae. May be tearful which can suggest depression. Before a diagnosis of anxiety disorder is made, physicians must rule out drug-induced anxiety and medical causes.
The single largest category of anxiety disorders is that of phobic disorders, which includes all cases in which fear and anxiety is triggered by a specific stimulus or situation. Between 5% and 12% of the population worldwide suffer from phobic disorders. Sufferers typically anticipate terrifying consequences from encountering the object of their fear, which can be anything from an animal to a location to a bodily fluid to a particular situation. Sufferers understand that their fear is not proportional to the actual potential danger but still are overwhelmed by the fear.
In panic disorder, a person suffers from brief attacks of intense terror and apprehension, often marked by trembling, shaking, confusion, dizziness, nausea, or difficulty breathing. These panic attacks, defined by the APA as fear or discomfort that abruptly arises and peaks in less than ten minutes, can last for several hours and can be triggered by stress, fear, or even exercise; the specific cause is not always apparent.
In addition to recurrent unexpected panic attacks, a diagnosis of panic disorder requires that said attacks have chronic consequences: either worry over the attacks' potential implications, persistent fear of future attacks, or significant changes in behavior related to the attacks. Accordingly, those suffering from panic disorder experience symptoms even outside specific panic episodes. Often, normal changes in heartbeat are noticed by a panic sufferer, leading them to think something is wrong with their heart or they are about to have another panic attack. In some cases, a heightened awareness (hypervigilance) of body functioning occurs during panic attacks, wherein any perceived physiological change is interpreted as a possible life-threatening illness (i.e., extreme hypochondriasis).
Agoraphobia is the specific anxiety about being in a place or situation where escape is difficult or embarrassing or where help may be unavailable. Agoraphobia is strongly linked with panic disorder and is often precipitated by the fear of having a panic attack. A common manifestation involves needing to be in constant view of a door or other escape route. In addition to the fears themselves, the term agoraphobia is often used to refer to avoidance behaviors that sufferers often develop. For example, following a panic attack while driving, someone suffering from agoraphobia may develop anxiety over driving and will therefore avoid driving. These avoidance behaviors can often have serious consequences; in severe cases, one can be confined to one's home.
Social anxiety disorder
Social anxiety disorder (SAD; also known as social phobia) describes an intense fear and avoidance of negative public scrutiny, public embarrassment, humiliation, or social interaction. This fear can be specific to particular social situations (such as public speaking) or, more typically, is experienced in most (or all) social interactions. Social anxiety often manifests specific physical symptoms, including blushing, sweating, and difficulty speaking. As with all phobic disorders, those suffering from social anxiety often will attempt to avoid the source of their anxiety; in the case of social anxiety this is particularly problematic, and in severe cases can lead to complete social isolation.
Obsessive–compulsive disorder (OCD) is a type of anxiety disorder primarily characterized by repetitive obsessions (distressing, persistent, and intrusive thoughts or images) and compulsions (urges to perform specific acts or rituals). It affects roughly around 3% of the population worldwide. The OCD thought pattern may be likened to superstitions insofar as it involves a belief in a causative relationship where, in reality, one does not exist. Often the process is entirely illogical; for example, the compulsion of walking in a certain pattern may be employed to alleviate the obsession of impending harm. And in many cases, the compulsion is entirely inexplicable, simply an urge to complete a ritual triggered by nervousness.
In a slight minority of cases, sufferers of OCD may only experience obsessions, with no overt compulsions; a much smaller number of sufferers experience only compulsions.
Post-traumatic stress disorder
Post-traumatic stress disorder (PTSD) is an anxiety disorder which results from a traumatic experience. Post-traumatic stress can result from an extreme situation, such as combat, natural disaster, rape, hostage situations, child abuse, bullying or even a serious accident. It can also result from long term (chronic) exposure to a severe stressor, for example soldiers who endure individual battles but cannot cope with continuous combat. Common symptoms include hypervigilance, flashbacks, avoidant behaviors, anxiety, anger and depression.There are a number of treatments which form the basis of the care plan for those suffering with PTSD. Such treatments include cognitive behavioral therapy (CBT), psychotherapy and support from family and friends.
Body Dysmorphic disorder
Body dysmorphic disorder (BDD, also body dysmorphia, dysmorphic syndrome; originally dysmorphophobia) is a type of mental illness, a somatoform disorder, wherein the affected person is concerned with body image, manifested as excessive concern about and preoccupation with a perceived defect of their physical features. The person thinks they have a defect in either one feature or several features of their body, which causes psychological distress that causes clinically significant distress or impairs occupational or social functioning. Often BDD co-occurs with emotional depression and anxiety, social withdrawal or social isolation.
The causes of body dysmorphic disorder are different for each person, usually a combination of biological, psychological, and environmental factors. Certain types of psychological trauma stemming from mental and physical abuse, or emotional neglect, can contribute to a person developing BDD. The onset of the symptoms of a mentally unhealthy preoccupation with body image occurs either in adolescence or in early adulthood, whence begins self-criticism of the personal appearance, from which develop atypical aesthetic-standards derived from the internal perceptual discrepancy between the person's ‘actual self’ and the ‘ideal self’. The symptoms of body dysmorphia include psychological depression, social phobia, and obsessive compulsive disorder. The affected individual may become hostile towards family members for no reason.
BDD is linked to a diminished quality of life, can be co-morbid with major depressive disorder and social phobia (chronic social anxiety); features a suicidal ideation rate of 80 percent, in extreme cases linked with dissociation, and thus can be considered a factor in the person's attempting suicide. BDD can be treated with either psychotherapy or psychiatric medication, or both; moreover, cognitive behavioural therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) are effective treatments. Although originally a mental-illness diagnosis usually applied to women, body dysmorphic disorder occurs equally among men and women, and occasionally in children and older adults. About 76% of parents think their child is either over conceited or simply lying about their condition. Approximately one to two percent (1–2%) of the world's population meets the diagnostic criteria for body dysmorphic disorder.