3.4 Anxiety disorders
Fear, anxiety and worry are part of normal experience and can all be very useful, as we have seen. However, when they become exaggerated, or attached to inappropriate stimuli or situations, they can interfere with normal functioning and cause immense distress. Anxiety disorders are characterised by constant or intense feelings of apprehension, uncertainty and fear. These feelings are one extreme of a continuum from ‘normal’ fear to anxiety – the responses differ not in kind but in degree. Both involve the ‘fight or flight’ system that comes into play in situations of actual or perceived danger. Table 3 shows a range of anxiety disorders together with brief descriptions of their symptoms.
Table 3 Anxiety disorders (from Bear et al., 2007 adapted from DSM-IV-TR (APA, 2000)).
|Panic disorder (PD)||Frequent panic attacks consisting of discrete periods with the sudden onset of intense apprehension, fearfulness, or terror, often associated with feelings of impending doom|
|Agoraphobia||Anxiety about, or the avoidance of, places or situations from which escape might be difficult or embarrassing, or in which help may not be available in the event of a panic attack|
|Obsessive-compulsive disorder (OCD)||Obsessions, which cause marked anxiety or distress, and/or compulsions, which serve to neutralise anxiety in the short term|
|Generalised anxiety disorder (GAD)||At least 6 months of persistent and excessive anxiety and worry|
|Specific phobia||Clinically significant anxiety provoked by exposure to a specific feared object (such as birds or blood) or situation, often leading to avoidance behaviour|
|Social phobia (or social anxiety)||Clinically significant anxiety provoked by exposure to certain types of social or performance situations, often leading to avoidance behaviour|
|Post-traumatic stress disorder (PTSD)||The re-experiencing of an extremely traumatic event, accompanied by symptoms of increased arousal and the avoidance of stimuli associated with the trauma|
Some anxiety disorders, such as phobias, appear to be provoked by fear of a specific danger (Table 3). In others, such as GAD, no specific object is known to pose a threat, but strong anxiety is chronic, present almost daily for months on end. In the rest of this section we will focus on GAD.