What is Anxiety Disorder
Anxiety is normal! It’s the body’s natural reaction to stress. The activation of the sympathetic nervous system triggers this. Our body only has one stress response system, so it doesn’t matter whether that stress comes from you running away from the bear or you taking an exam.
Anxiety Disorder is NOT normal. This is when the normal feeling of anxiety is turned up out of proportion leading to an out-of-place reaction and excess of fear. Before we get too far, let’s define fear. Fear is an emotional response to the immediate threat, the “flight” or “fight.” (Or sleep in little kids)
When people think about mental disorders, they usually think about either depression or anxiety. These two disorders are very common but are also very different! One of the ways that they are different is that patients with depression usually focus on what happened in the past (to them), and patients with anxiety usually focus on what’s going to happen in the future.
Neurophysiology of Anxiety
There are two main regions of the brain that are associated with anxiety: The amygdala-centered circuit and the cortico-striato-thalamo-cortical circuit.
The stimulation of the amygdala has been known to induce panic and fear, and the stimulation of cortico-striato-thalamo-cortical circuit induces anxious misery, apprehension, expectations, and obsession.
What treatments have been used to treat anxiety?
The Wolpe’s Theory: The Reciprocal Inhibition
This is a form of behavior therapy. The idea behind it is that because anxiety stems from sympathetic nervous system stimulation, we need to stimulate the parasympathetic to inhibit anxiety using responses that keep the sympathetic system turned off.
Avoidance
Avoidance is probably one of the most common ways that people handle anxiety disorders. This can lead to a significant impact on the patient’s life.
Operant Conditioning
Operant conditioning focuses on reinforcement and punishment combined with adding or removing stimuli to induce or inhibit certain actions.
- Adding stimuli (positive)
- If adding stimuli leads to a desired action, that is positive reinforcement.
- If adding the stimuli leads to inhibiting a desired action, that is positive punishment.
- Removing stimuli (negative)
- If removing stimuli leads to a desired action, that is negative reinforcement.
- If removing stimuli leads to inhibiting a desired action, that is negative punishment.
Quiz time: If you received a speeding ticket while going 15 miles over the speed limit, and now you don’t go over the speed limit anymore. What type of conditioning is this?
Positive Punishment because you add the stimuli of getting a speeding ticket that leads to inhibiting a desired action (speeding down the highway.)
Pavlov actually used this idea and developed it into “classical conditioning.” This is the idea of pairing an unconditioned stimulus with a neutral stimulus to create a conditioned response. Sounds confusing? Me too.
We use this technique in dog training a lot. We know that dogs salivate when they see food. We also know that before training, dogs generally don’t know how to respond to a whistle. By pairing the whistle with giving them food, the dogs will start to associate the whistle with food. In time, they will start salivating when hearing a whistle. This is called a conditioned response.
How do we diagnose Generalized Anxiety Disorder?
There are six components of GAD in the DSM-5
- Excessive anxiety and worry for at least 6 months
- Has difficulty controlling that anxiety
- Has at least three symptoms:
- Restlessness
- Easily fatigued
- Difficulty concentration
- Irritability
- Muscle tension
- Sleep disturbance
- This is causing significant distress or impairment
- Anxiety not caused by any medication
- Methamphetamine, corticosteroids
- Anxiety not due to other medical or mental condition
- Hyperthyroidism
How do we diagnose Panic Disorder?
Panic Disorder is a sudden onset of sympathetic arousal. According to the DSM-5, this sudden onset is accompanied by at least four symptoms:
- Palpitation
- Abnormal sweating
- Shaking
- Shortness of Breath
- Feeling smothered
- Feeling choking
- Discomfort
- Dizziness
- Chills
- Numbness
- Derealization or depersonalization
- Fear of losing control
- Fear of death
AND the sudden onset is followed by a month of either persistent worrying about having more panic attacks or significant abnormal changes in behavior, or both.
Just like GAD, this cannot be due to other medications or health conditions.
Please note that anxiety or panic attacks can lead to another condition called agoraphobia, which means the fear of leaving home. This is another form of avoidance.
How to diagnose Social Anxiety Disorder (SAD)?
SAD is a marked fear or anxiety about one or more social situation and the worry that they’re going to be negatively judged. This leads to social avoidance.
According to the DSM-5, for someone to be diagnosed with SAD, this social anxiety must be persistent and severe. Typically, this last for 6 months or more.
Selective Mutism
Selective mutism is a rare disorder. This disorder is more common in little kids, and it happens when they are talkative in a private setting but become mute in public. This disorder usually occurs before the age of 5 and can be due to extreme shyness or fear of social embarrassment.
Risk Factors for Anxiety Disorders:
- Temperament
- Adverse childhood experience
- Relatives with anxiety
- Medications (alcohols, opioids, BZDs)
We prefer psychotherapy for anxiety because medications can only act as bandages and reduce the symptoms temporarily.
Last note about anxiety
Anxiety is very common. It has been shown to be more common in women than men and in a younger population than the older population.