Anxiety

Within the DSM-5 there are multiple disorders that fall under the classification of “Anxiety Disorders” however we will focus on the most common being Generalized Anxiety Disorder, and a few others known as Panic Disorder, Post-Traumatic Stress Disorder (PTSD), Adjustment Disorder, and Obsessive Compulsive Disorder (OCD). Most of the anxiety disorders are more common in females.

Generalized Anxiety Disorder (GAD) is described as chronic excessive worry and is often accompanied by restlessness, insomnia, muscle tension and problems with concentration. Often anxiety disorders are present from a young age but may become exacerbated during a later period in life. The lifetime prevalence is estimated to be between 4-7%. Risk factors for GAD include being female, have a family history of anxiety disorders, past trauma or history of abuse and low socioeconomic status. It is very common for depression to be comorbid with anxiety (over 50% have both diagnoses). Luckily, the treatment for anxiety disorders is complementary to depressive disorders. Antidepressants, such as the SSRIs previously discussed, help with long term treatment of anxious symptoms, as does psychotherapy like CBT. Medications like benzodiazepines may be used to alleviate severe anxiety short term, however caution must be paid when using these medications as individuals can become dependent on them.

Panic Disorder is characterized by unexpected, recurrent panic attacks which are acute onset of fear, heart palpitations, chest pain, shortness of breath, neurological symptoms, and/or sweating that can happen without a known trigger and last several minutes to an hour.  As a result of such attacks, there may be one month or greater of fear behaviours related to having another attack, most commonly avoidance of situations in which the individual thinks they may have a panic attack which can result in social phobia.  The current treatment for panic disorder involves medications such as those described for GAD.

Post-Traumatic Stress Disorder (PTSD) follows the experience of a significantly traumatic event of which chronic symptoms include intrusive thoughts, nightmares and flashbacks, severe anxiety, avoidance of reminders of the trauma, sleep disturbances, and impairment in daily life. PTSD is common after trauma such as military conflict, physical or sexual assault, natural or manmade disasters, or a diagnosis of a life threatening illness and the symptoms typically begin within the months following the trauma. Psychiatric medications as well as psychotherapy may aid in the improvement of PTSD symptoms. You can learn more about PTSD here.

Adjustment Disorder is similar to PTSD in that it often follows a stressful life event, however it is often milder in nature than the trauma faced prior to PTSD symptom onset.  Causes of adjustment disorder may include the death of a loved one, relationship problems, life changes, illness, moving, financial problems, school/work problems, etc. Symptoms faced during an adjustment disorder include impulsive or defiant behaviour, nervousness, crying, sadness or feelings of hopelessness, withdrawal from supportive relationships, and psychomotor agitation. These symptoms must be a result of a stressor within the last three months and are exaggerated or out of proportion to what would be an expected reaction. Psychotherapy is the primary treatment recommendation for adjustment disorder but medications may also be used in combination therapy.

Obsessive Compulsive Disorder (OCD) consists of recurrent, intrusive thoughts or urges (obsessions) that cause distress and/or actions (compulsions) that an affected individual feels driven to perform to alleviate their distress. OCD tendencies are often apparent in childhood and adolescence and persist throughout the lifespan, if not treated these symptoms can cause marked functional impairment in day to day life. Common obsessions include fear of contamination, excessive preoccupation with symmetry or images of violent scenes, they are not pleasurable, voluntary or wanted. Common resulting compulsions include repetitive behaviours such as washing and checking doors are locked or the stove is off in excessive proportions. Similar medications and psychotherapy are used for the treatment of OCD as many of the other anxiety disorders.