Anxiety disorders are the most prevalent mental disorders in the general population. Several psychological factors have been associated with an increased risk of anxiety disorders. Anxiety sensitivity has been defined as an individual’s response to the physiological changes that accompany anxiety and fear.
Patients with anxiety disorders exhibit exaggerated psychological reactions that reflect misinterpretations of bodily signals, such that these sensations are inappropriately perceived as harmful and dangerous, leading to a spiraling increase in anxiety and fear.
It has become clear that there is an inherited neurobiological predisposition to heightened physiological reactivity and anxiety symptoms in the context of unfamiliar environments. Excessive parental overprotection, excessive criticism and lack of warmth, poverty, exposure to violence, social isolation, and repeated losses of significant interpersonal relationships are risk factors for the development of anxiety disorders.
Panic Disorder
Panic disorder is diagnosed only when panic attacks are recurrent and unexpected, while the patient has a persistent fear of experiencing another attack for at least one month.
A panic attack is a dramatic and spontaneous increase in fear and distress, accompanied by multiple physical symptoms. It is a symptom that occurs in several anxiety disorders. An episode is considered a panic attack when at least four of the following physical symptoms are present within 10 minutes of the onset of the episode:
1. Palpitations or rapid heartbeat
2. Sweating
3. Trembling or shaking
4. Sensation of shortness of breath or difficulty breathing
5. Feeling of choking
6. Nausea or abdominal discomfort
7. Chest pain or discomfort
8. Dizziness, vertigo, unsteadiness, or feeling faint
9. Feelings of unreality (derealization), or feeling detached from oneself (depersonalization)
10. Fear of going crazy or doing something uncontrolled during the attack
11. Fear of dying
12. Paresthesias (numbness or tingling sensations)
13. Chills or hot flushes
A panic attack may be:
• Unexpected and spontaneous (unprovoked).
• Situationally bound, with a situational trigger (e.g., a snake) (provoked).
• Situationally predisposed, meaning that it may occur during a situation that provokes anxiety (e.g., in an elevator).
Agoraphobia
Agoraphobia refers to the fear of being in places or situations from which escape may be difficult, or in which help may be unavailable or ineffective if the person develops a symptom that could be disabling or distressing.
Typical symptoms include dizziness, falling to the ground, loss of bladder or bowel control, and chest pain. This fear causes the person to restrict travel or to seek a companion when leaving home.
As a rule, in clinical practice, panic attacks and agoraphobia are encountered together more often than separately. Typically, panic attacks occur first, while agoraphobia develops in response to these episodes and becomes associated with places where the person has experienced panic attacks in the past.
Generalized Anxiety Disorder
Generalized anxiety disorder is characterized by excessive worry. Its presentation varies considerably from person to person. At least three of the following symptoms must have been present for most of the time during the previous six months:
• Restlessness, feeling keyed up or on edge
• Being easily fatigued
• Difficulty concentrating or difficulty remembering
• Irritability
• Muscle tension
• Sleep disturbance
Phobias
A phobia is a recurrent and unreasonable fear of a particular object, activity, or situation, which leads to a compelling desire to avoid the source of the fear, even though the affected person recognizes that the fear is exaggerated and unrealistic in relation to the actual danger posed by the object, activity, or situation.
When a phobia impairs a person’s ability to carry out normal daily activities, a diagnosis of a phobic disorder is justified. Phobias are divided into three main categories:
Agoraphobia
Fear of being alone or in public places from which escape may be difficult, or where help may not be available in the event of sudden incapacitation.
Specific Phobias
Fear of specific objects or situations, such as snakes or heights (as opposed to being alone, being away from home, or experiencing distress in public).
Social Phobia
Fear, distress, or humiliation in public situations.
References:
Kaplan & Sadock: Synopsis of Psychiatry, twelfth edition
Kaplan & Sadock: Pocket Handbook of Clinical Psychiatry, fifth edition;
American Psychiatric Association: Diagnostic Manual of Mental Disorders, 1994;
Robert J. Waldinger: Psychiatry for Medical Students, third edition, translated by Anastas Suli.