(9-17-07)
Epidemiology of anxiety disorders
- Clinic vs. population studies of the prevalence of anxiety disorders
- population studies have found anxiety disorders to be the most common mental disorders in the general population (ECA; NCS). [This often cited result actually dependes somewhat on whether you include substance abuse in the mix and (if you do), how you operationalize (count) cases of alcohol abuse and tobacco depenence. Nevertheless, anxiety disorders are common and among the most frequently occurring mental disorders. Dr. H.]
- ECA: Epidemiologic Catchment Area (ECA) Study (Robins & Regier, 1991; Robins, Locke, & Regier, 1991)
- Door to door assessments of approximately 20,000 people in five large metropolitan areas of U.S. in 1980s assessing prevalence of mental disorders with structured interviews
- NCS: The National Comorbidity Survery (NCS) (Kessler et al., 1995)
- Assessment of approximately 8,000 people throughout U.S. between the ages of 15 and 54
- ECA: Epidemiologic Catchment Area (ECA) Study (Robins & Regier, 1991; Robins, Locke, & Regier, 1991)
- only about 25% of people with a diagnosable anxiety disorder ever seek treatment (Oltmanns & Emery, 2004, p. 201)
- population studies have found anxiety disorders to be the most common mental disorders in the general population (ECA; NCS). [This often cited result actually dependes somewhat on whether you include substance abuse in the mix and (if you do), how you operationalize (count) cases of alcohol abuse and tobacco depenence. Nevertheless, anxiety disorders are common and among the most frequently occurring mental disorders. Dr. H.]
- Gender differences in prevalence of anxiety disorders
- Age differences in anxiety
- Anxiety disorders have been reported to decline in senior citizen samples
- Comorbidity of anxiety disorders
- Anxiety disorders are often comorbid with other anxiety disorders
- Anxiety disorders are often comorbid with mood disorders
- Anxiety disorders are often comorbid with substance use disorders
- Some anxiety disorders show association with increased suicide risk
- Comorbidity is often associated with poorer outcomes in treatment studies
- Cormorbidity remains a controversal and poorly understood phenomenon
- Cultural differences in anxiety
- In the Cross-National Collaborative Panic Study (1992) over 1,000 patients were treated with different medications for panic attacks in 14 different nations in North America, Latin America, and Europe. Note: this is a clinic sample study
- While panic disorder occurred in all the countries included in this study, differences were noted in the frequencies of particular symptoms:
- Choking or smothering and fear of dying were more common among patients from southern countries in both the Americas and in Europe
- Phobic avoidance was much more common among phobic patients seen in clinics in the U.S. and in Canada (90%)
- A commonly reported clinical belief is that indivduals from many Asian cultures are more likely to present with “somantic” concerns (complaints of aches, pain, fatigue, stomach upset, sleep disturance) than with “psychological” concerns (anxiety, depression). While there is some support for this observation it does not hold for all individuals from these cultures and such stereotypes (even when based in reality) should be considered very cautiously.
- In the Cross-National Collaborative Panic Study (1992) over 1,000 patients were treated with different medications for panic attacks in 14 different nations in North America, Latin America, and Europe. Note: this is a clinic sample study
Traditional psychiatric classification of anxiety disorders has focused on commonly recognized patterns of anxiety symptoms
DSM-IV-TR Anxiety Disorders
- Panic Disorder
- Panic Disorder Without Agoraphobia
- Panic Disorder With Agoraphobia
- Agoraphobia Without History of Panic Disorder
- Phobia
- Specific Phobia
- Social Phobia
- Obsessive-Compulsive Disorder (OCD)
- intrusive thoughts and rituals
- OCD in literature and drama: Lady MacBeth, “As Good as it Gets”, Monk
- Posttraumatic Stress Disorder (PTSD)
- History of a concept: PTSD
- Civil War “nostalgia”
- World War I “shell shock”
- World War II “combat exhaustion”
- Korean Conflict “battle neurosis”
- Viet Nam Conflict “posttraumatic stress disorder”
- pattern:
- 1) exposure to event; experienced/witnessed events threatening death/serious injury/threat to physical integrity of self or others; & experienced intense fear/helplessness/horror in response
- 2) trauma is
- a) reexperienced
- b) avoidance of associated stimuli/numbing of general responsiveness
- c) persistent increased arousal
- 3) reaction persists at least 1 month
- Acute Stress Disorder
- fewer symptoms required
- duration of at least 2 days; maximum 4 weeks
- History of a concept: PTSD
- Generalized Anxiety Disorder (GAD): chronic tension and over arousal
- Anxiety Disorder NOS
It is worth noting that anxiety symptoms are common in many other psychiatric disorders, including:
- Learning Disorders
- Communication Disorders
- Pervasive Developmental Disorders (Autism, Asperger’s Disorder)
- ADHD
- Tourette’s Disorder
- Separation Anxiety Disorder
- Cognitive Disorders
- Schizophrenia
- Substance Abuse and Dependence
- Mood Disorders (Depression, Bipolar Disorder)
- Impulse-Control Disorders
- some Dissociative Disorders
- some Somatoform Disorders
- some Sexual Disorders, Paraphilias, and Gender Identity Disorders
- some Sleep Disorders
- some Adjustment Disorders
- some Personality Disorders
- and many Other Conditions That May Be A Focus of Clinical Attention
- Excessive anxiety and problems in handling anxiety is one of the major ways that you and I get ourselves into difficul
Gender differences in anxiety disorders
| Disorder | Females (%) | Males (%) |
| any anxiety disorder | 22.6 | 11.8 |
| panic disorder | 3.2 | 1.3 |
| agoraphobia without PD | 3.8 | 1.7 |
| social phobia | 9.1 | 6.6 |
| specific phobia | 13.2 | 4.4 |
| generalized anxiety disorder | 4.3 | 2.0 |
| obsessive-compulsive disorder | 1.9 | 1.4 |
Panic
(9-15-06)
Panic Episodes (panic attacks) are discrete episodes of extreme anxiety, fear, arousal. They tend to be relatively brief (10 to 20 minutes is common) although the individual’s perception may be that they are unending. They may be precipitated by environmental stimuli (phobias can be thought of as panic episodes elicited by specific stimuli), may be predisposed to occur in certain environmental circumstances (crowds, places from which escape would be difficult), or may occur “out of the blue.” In predisposed individuals, panic episodes can often be elicited by hyperventilation. Mildly increasing carbon dioxide may help end a panic experience (breathing into a paper bag).
Common symptoms of panic attacks are:
- awareness of your heart beating rapidly
- awareness of your heart “pounding”
- numbness or tingling sensations
- chills or hot flashes
- sweating
- trembling or shaking
- feeling shortness of breath or smothering
- feeling of choking
- nausea or stomach distress
- dizziness, lightheadedness, or faintness
- feeling of unreality or being detached from oneself
- fear of losing control or going crazy
- fear of having heart attack or dying
- feeling of having to escape or leave situation
These are all symptoms of high levels of anxiety. When four or more of these symptoms occur together a panic episode is occurring. Several panic episodes within a few week period (with at least some being “uncued”) is the usual clinical definition of a panic disorder. A panic episode is absolutely terrifying for the individual and they often feel as if real death or some unnamed catastrophe is imminent. Frantic escape behavior can be generated. This is unfortunate because the panic attack will usually be ending anyway and this sets up “superstitious conditioning” of the escape behavior–accidental or noncontingent negative reinforcement of the escape behavior by the reduction of anxiety symptoms (You were going to feel better anyway in a few minutes but because this “happens” after you leave the situation, you feel as if running away was what helped you feel better.).
Phobia
(9-15-06)
Phobias: “a special form of fear”
Issac Mark’s 1969 definition of a phobia: A phobia is a special form of fear that is out of proportion to demands of the situation, cannot be explained or reasoned away, is beyond voluntary control, leads to avoidance of the feared situation, persists over an extended period of time, and is not adaptive. This perspective on extreme fears (phobias) influenced much of the empirical investigations and early efforts at objective conceptualization of mental and emotional disorders which lead to our current understanding of phobias (and DSM)