Anxiety Disorders: Just What Are They? – Part 2

by Mike Nichols – Posted in: Anxiety

Many readers of this blog have requested short descriptions of the various Anxiety Disorders.

Detailed descriptions are available under the “Reference and Information” section of the right sidebar, but I realized that I had never provided a synopsis of each Anxiety Disorder.

This is the second in a two-part series briefly describing the major Anxiety Disorders. It covers:

Panic attacks
Panic Disorder
Post Traumatic Stress Disorder (PTSD)
Social Anxiety Disorder, also known as Social Phobia (SAD)
Specific phobias

Panic attacks

A sudden surge of overwhelming fear

A panic attack is a sudden surge of overwhelming fear that comes without warning and without any obvious reason. It is far more intense than the feeling of being “stressed out” that most people experience.

Symptoms include a pounding heart, sweating, shortness of breath or a feeling of choking, feelings of unreality and the fear of going crazy or dying. In addition to these and other symptoms, a panic attack is marked by:

occurring suddenly, without any warning and without any way to stop it
the level of fear is way out of proportion to the actual situation, and is often completely unrelated
it passes in a few minutes, however, repeated attacks can continue to recur for hours

Panic attacks affect from 9.1 million to 17 million people in the United States. Women are up to three times as likely to have panic attacks as men.

The Diagnostic and Statistical Manual of Mental Disorders lists the following criteria for a panic attack:

A discrete period of intense fear or discomfort, in which four (or more) of the following symptoms developed abruptly and reached a peak within 10 minutes:

1. palpitations, pounding heart, or accelerated heart rate

2. sweating

3. trembling or shaking

4. sensations of shortness of breath or smothering

5. feeling of choking

6. chest pain or discomfort

7. nausea or abdominal distress

8. feeling dizzy, unsteady, lightheaded, or faint

9. derealization (feelings of unreality) or depersonalization (being detached from oneself)

10. fear of losing control or going crazy

11. fear of dying

12. paresthesias (numbness or tingling sensations)

13. chills or hot flushes

Panic attacks reach a crescendo within ten minutes and typically last fifteen minutes. However, they may recur rapidly, and once the symptoms abate, a severely anxious state may not go away for several hours.

Panic Disorder

Panic Disorder is the most treatable of the Anxiety Disorders

Panic Disorder is at the same time the most treatable of the Anxiety Disorders, and the most devastating. It can progress very quickly from the first panic attack to major Anxiety to Agoraphobia if untreated. Panic attacks mimic dire physical problems such as heart attack, and disabling fear is characteristic of Panic Disorder.

Panic disorder and panic attacks are hard to separate from one another: One must have panic attacks to have Panic Disorder, but one can have a panic attack without having Panic Disorder.

The National Institute of Mental Health (NIMH) estimates that about 2 percent of American adults — six million people — have Panic Disorder. It is twice as common in women as among men. As many as thirty-six percent of people with Panic Disorder also have Agoraphobia.

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) lists the criteria for Panic Disorder as follows:

A. Both (1) and (2)

1. Recurrent unexpected Panic Attacks

2. At least one of the attacks has been followed by 1 month (or more) of one (or more) of the following:

– Persistent concern about having additional attacks
– Worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, “going crazy”)
– A significant change in behavior related to the attacks

B. The Panic Attacks are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism).

C. The Panic Attacks are not better accounted for by another mental disorder.

Post Traumatic Stress Disorder (PTSD)

PTSD reaction to extreme psychological trauma

PTSD is an Anxiety Disorder that can develop after exposure to one or more terrifying events in which grave physical harm occurred or was threatened. It is a severe and ongoing emotional reaction to an extreme psychological trauma. The PTSD sufferer is affected to a degree that usual psychological defenses are incapable of coping.

The National Institute of Mental Health (NIMH) says that PTSD currently affects about 7.7 million American adults.The Mayo Clinic states that 7 to 8 percent of the population, about 24 million, will have PTSD at some time in their lives. Women are more likely to develop PTSD than men.

The Diagnostic and Statistical Manual of Mental Disorders lists the diagnostic criteria for PTSD as follows:

A. The person has been exposed to a traumatic event in which both of the following have been present:

(1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others

(2) the person’s response involved intense fear, helplessness, or horror.

B. The traumatic event is persistently reexperienced in one (or more) of the following ways:

(1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions.

(2) recurrent distressing dreams of the event.

(3) acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur upon awakening or when intoxicated).

(4) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

(5) physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:

(1) efforts to avoid thoughts, feelings, or conversations associated with the trauma

(2) efforts to avoid activities, places, or people that arouse recollections of the trauma

(3) inability to recall an important aspect of the trauma

(4) markedly diminished interest or participation in significant activities

(5) feeling of detachment or estrangement from others

(6) restricted range of affect (e.g., unable to have loving feelings)

(7) sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:

(1) difficulty falling or staying asleep

(2) irritability or outbursts of anger

(3) difficulty concentrating

(4) hypervigilance

(5) exaggerated startle response

E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than one month.

F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Social Anxiety Disorder, also known as Social Phobia (SAD)

SAD is overwhelming anxiety and self-consciousness

SAD is an Anxiety Disorder characterized by overwhelming anxiety and excessive self-consciousness in everyday social situations. People with SAD have a persistent, intense, and chronic fear of being watched and judged by others and of being embarrassed or humiliated by their own actions.

Individuals with SAD typically become intensely anxious, with increased heart rate, sweating, and other signs of nervous arousal during a social encounter. They may experience symptoms resembling a panic attack. These physical symptoms may cause additional anxiety, often leading to a habitual fear response that reinforces the anxiety of public situations.

SAD is considered a disorder if it is severe enough to adversely affect social or occupational functioning. Although it is common for many people to experience some anxiety before or during a public appearance, anxiety levels in people with SAD can become so high that they begin to avoid social situations. This fear may become so severe that it interferes with work, school, and other ordinary activities, and can make it hard to make and keep friends.

The National Institute of Mental Health says that SAD affects about 5 percent, or 15 million people. Women are twice as likely to develop the SAD as men. However, men are more likely to seek treatment.

According to the US National Comorbidity Survey, SAD is the third most common psychiatric disorder in the United States after depression and alcohol dependence.

The Diagnostic and Statistical Manual of Mental Disorders lists the diagnostic criteria for SAD as follows:

A. A marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing.

B. Exposure to the feared social situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally predisposed Panic Attack.

C. The person recognizes that the fear is excessive or unreasonable.

D. The feared social or performance situations are avoided or else are endured with intense anxiety or distress.

E. The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person’s normal routine, occupational (academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.

F. The fear or avoidance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition and is not better accounted for by another mental disorder

Specific Phobias

Strong, irrational, and involuntary reactions

The key to the fear reactions of Specific Phobias is the strong, irrational, and involuntary reactions in the presence of or the anticipation of a specific place, object or situation. It causes people to avoid common everyday places, situations or objects, even though they logically know there isn’t any threat of danger. The Specific Phobia sufferer knows that their reaction is irrational, but even thinking about it can cause extreme anxiety.

There are many Specific Phobias. Acrophobia is a fear of heights. Other common phobias involve tunnels, highway driving, water, flying, animals and blood.

People with Specific Phobias try to avoid what they are afraid of. This avoidance is a key feature of the Anxiety Disorders. If a feared object or situation cannot be avoided, a person may experience:

Panic and fear
Rapid heartbeat
Shortness of breath
Trembling
A strong desire to get away

When confronted with the feared situation or object, they may even have a panic attack.

Part one of Anxiety Disorders: Just What Are They?

Part one of this series covered the following Anxiety Disorder subjects:

What do you think?

These Anxiety Disorders are a catalog of human misery. But it doesn’t have to be that way. Most of the Disorders respond well and quickly to treatment using psychotherapy and/or medications. I urge you to contact a qualified mental health professional if you suspect you may have any of these Anxiety Disorders.

Have you had any of these Anxiety Disorders? What did it feel like?
Do you think that the prevalence of these Disorders is over-estimated?
Do you think that these summaries were too long?

As always, your comments are welcome!

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Resources used in this post:

American Psychiatric Association. (2007). Anxiety — Let’s Talk Facts. Retrieved June 22, 2008, from American Psychiatric Association Web site (PDF): http://www.healthyminds.org/multimedia/anxietydisorders.pdf

Anxiety Disorders Association of America. (2008). Statistics and Facts About Anxiety Disorders. Retrieved June 26, 2008 from Anxiety Disorders Association of America Web site: http://adaa.org/AboutADAA/PressRoom/Stats&Facts.asp

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Arlington, VA: American Psychiatric Association. 1994.

National Institute of Mental Health. (2006). Anxiety Disorders Introduction. Retrieved June 23, 2008, from National Institute of Mental Health. Web site: http://www.nimh.nih.gov/health/publications/anxiety-disorders/introduction.shtml

National Institute of Mental Health. (2008, June 26). The Numbers Count: Mental Disorders in America. Retrieved August 28, 2008 from National Institute of Mental Health Web site: http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america.shtml

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