TABLE 163 Anxiety Disorders

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Anxiety disorders cause great distress and impair function, but those affected are not psychotic. The disorders are distinguished by the symptoms, the entities feared, or the stressors.

Panic Disorder

Agoraphobia Specific Phobia

Social Phobia




Acute Stress Disorder

Posttraumatic Stress Disorder

Generalized Anxiety Disorder

A panic disorder is defined by recurrent, unexpected panic attacks, at least one of which has been followed by a month or more of persistent concern about further attacks, worry over their implications or consequences, or a significant change in behavior in relation to the attacks.

A panic attack is a discrete period of intense fear or discomfort that develops abruptly and peaks within 10 minutes. It involves at least four of the following symptoms: (1) palpitations, pounding heart, or accelerated heart rate, (2) sweating, (3) trembling or shaking, (4) shortness of breath or a sense of smothering, (5) a feeling of choking, (6) chest pain or discomfort, (7) nausea or abdominal distress, (8) feeling dizzy, unsteady, lightheaded, or faint, (9) feelings of unreality or depersonalization, (10) fear of losing control or going crazy, (11) fear of dying, (12) paresthesias (numbness or tingling), (13) chills or hot flushes.

Panic disorder may occur with or without agoraphobia.

Agoraphobia is an anxiety about being in places or situations where escape may be difficult or embarrassing or help for sudden symptoms unavailable. Such situations are avoided, require a companion, or cause marked anxiety.

A specific phobia is a marked, persistent, and excessive or unreasonable fear that is cued by the presence or anticipation of a specific object or situation, such as dogs, injections, or flying. The person recognizes the fear as excessive or unreasonable, but exposure to the cue provokes immediate anxiety. Avoidance or fear impairs the person's normal routine, occupational or academic functioning, or social activities or relationships.

A social phobia is a marked, persistent fear of one or more social or performance situations that involve exposure to unfamiliar people or to scrutiny by others. Those afflicted fear that they will act in embarrassing or humiliating ways, as by showing their anxiety. Exposure creates anxiety and possibly a panic attack, and the person avoids precipitating situations. He or she recognizes the fear as excessive or unreasonable. Normal routines, occupational or academic functioning, or social activities or relationships are impaired.

This disorder involves obsessions or compulsions that cause marked anxiety or distress. While they are recognized at some point as excessive or unreasonable, they are very time consuming and interfere with the person's normal routine, occupational functioning, or social activities or relationships.

The person has been exposed to a traumatic event that involved actual or threatened death or serious injury to self or others and responded with intense fear, helplessness, or horror. During or immediately after this event, the person has at least three of these dissociative symptoms: (1) a subjective sense of numbing, detachment, or absence of emotional responsiveness; (2) a reduced awareness of surroundings, as in a daze; (3) feelings of unreality; (4) feelings of depersonalization; and (5) amnesia for an important part of the event. The event is persistently reexperienced, as in thoughts, images, dreams, illusions, and flashbacks, or distress from reminders of the event. The person is very anxious or shows increased arousal and tries to avoid stimuli that evoke memories of the event. The disturbance causes marked distress or impairs social, occupational, or other important functions. The symptoms occur within 4 weeks of the event and last from 2 days to 4 weeks.

The event, the fearful response, and the persistent reexperiencing of the traumatic event resemble those in acute stress disorder. Hallucinations may occur. The person has increased arousal, tries to avoid stimuli related to the trauma, and has numbing of general responsiveness. The disturbance causes marked distress, impairs social, occupational, or other important functions, and lasts for more than a month.

This disorder lacks a specific traumatic event or focus for concern. Excessive anxiety and worry, which the person finds hard to control, are about a number of events or activities. At least three of the following symptoms are associated: (1) feeling restless, keyed up, or on edge, (2) being easily fatigued, (3) difficulty in concentrating or mind going blank, (4) irritability, (5) muscle tension, (6) difficulty in falling or staying asleep, or restless, unsatisfying sleep. The disturbance causes significant distress or impairs social, occupational, or other important functions.

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