Anxiety Disorders

1. Anxiety Disorders Assessment & Diagnosis SW 593

2. Introduction • Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults. • Anxiety disorders are chronic, relentless, and can grow progressively worse if not treated. • Each anxiety disorder has its own distinctive features, but they are all bound together by the common theme of excessive, irrational fear and dread.

3. Building Blocks • Two non-codable disorders: • Agoraphobia – anxiety focused on situations or places from which the client may not be able to escape and/or receive help if the anxiety were to become too acute. • Panic attack – an episode of anxiety usually lasting less than a half hour during which the client experiences a number of physical complaints and/or cognitive fears about the outcome of the “attack”.

4. Phobias • Specific Phobias: • the client fears some specific object or situation. • The phobia is directly related to a discernible event and is understood by the client to be an “overreaction”. • Social Phobia: • The specific fear involves at least one type of social or performance situation that involves being “judged” by others.

5. Generalized Anxiety • Concern is usually focused on everyday events and tends to shift over a number of events or activities. • The client may not view the worries as excessive. • They do experience distress associated with an inability to control the concerns. • The condition is more chronic; must have persisted for at least 6 months.

6. Obsessive-Compulsive Disorder • Characterized by the presence of recurrent obsessions and/or compulsions. • Obsessions are intrusive and persistent thoughts, ideas, impulses, or images that are associated with marked anxiety or distress. • The specific content of obsessions does not usually involve any real-life problems.

7. Obsessive-Compulsive Disorder • Compulsions are repetitive behaviors that are performed to prevent or reduce anxiety. • These behaviors are clearly either excessive or not realistically associated with preventing or reducing the feared situation. • Clients suffering from this disorder have at one time realized that their symptoms are excessive or unreasonable, such insight may be tenuous.

8. Trauma Related Disorders • Associated with direct exposure to extreme traumatic events involving threats of serious injury or death to the client or another person. • Acute Stress Disorder: • Symptoms begin during or immediately after the trauma • Last for at least 2 days • Resolve within 4 weeks.

9. Trauma Related Disorders • The symptoms tend to be largely dissociative in nature • Include some form of re-experiencing the trauma • Lead to patterns of avoiding reminders of the event • If the symptoms are not resolved in the time period, another diagnosis is in order.

10. Trauma Related Disorders • Posttraumatic Stress Disorder (PTSD): • Symptoms have persisted for at least a month although the exposure to trauma may have occurred at any time prior to symptom onset. • Characterized by persistent re-experiencing of the traumatic event • Avoidance of stimuli associated with the trauma • Client evidences both numbing of general responses and persistent symptoms of arousal that were not present before the traumatic event.

11. Etiological Factors • Anxiety disorder due to a General Medical condition is used when the anxiety is directly related to a diagnosable organic problem. • Substance-Induced Anxiety Disorder is used when to anxiety is directly related to the use of recreational drugs, prescribed medications, or a toxin.

12. Worth Noting • People suffering from anxiety do not necessarily seek treatment. • Anxiety tends to be variable and many clients attain symptom relief through avoidance strategies. • Symptoms are relieved when stress is reduced. • Self - medication

13. Assessment • Attention will be focused on the person’s fears and worries. • It is difficult for clients to present detailed and accurate information. • Tendency to minimize symptoms because of internalized stigma. • When panic attacks are involved, collateral medical referrals are warranted.

14. Cultural Considerations • Culture undoubtedly influences what is viewed as anxiety-provoking. • Culture can influence what level of anxiety is considered problematic. • The standards for displays of emotion vary by gender. • Little differences are noticed between the sexes for social phobia, acute stress disorder, PTSD, GAD, and OCD.

15. Cultural Considerations • These all share either a link to an intense psychosocial stressor or a relatively private set of symptoms. • The female to male ratio for specific phobias and panic disorders is 2:1. • Some evidence indicates that males suffering from panic attacks are more likely to “self-medicate”.