3.2i Mental health disorders: Anxiety

Outline - Chapter 3

• Why do people develop mental health problems?
• Mental health disorders
  • Anxiety
  • Mood
  • Psychosis
  • Impulsivity
• Personality disorders

Anxiety disorders take on different forms. They are the most common type of mental health disorder. They have different causes and symptoms, but one thing people with anxiety disorders share is feelings of deep anxiety and fear that affect their mood, thinking and behaviour. When someone has an anxiety disorder, his or her thoughts and feelings may get in the way of taking the actions needed to be healthy and productive. These illnesses are chronic and can get worse over time if they are not treated. The following anxiety disorders:

• posttraumatic stress disorder
  • simple posttraumatic stress disorder
  • complex posttraumatic stress disorder
• generalized anxiety disorder
• panic disorder
• social phobia
• obsessive-compulsive disorder are described below.

Posttraumatic stress disorder

As we discussed in Chapter 1, many people who develop substance use and/or mental health problems have experienced, or are experiencing, sexual, physical, psychological or emotional trauma.

Experiencing a traumatic event may trigger mental health problems such as anxiety, depression, psychotic symptoms or personality disorders (SAMHSA, 2003). The DSM-IV diagnostic category posttraumatic stress disorder (PTSD) describes a set of symptoms that people may experience following a traumatic event.

Simple posttraumatic stress disorder

PTDS may develop after a person experiences or sees an event where serious physical harm occurred or was threatened. Symptoms include:

• re-experiences of the event through flashbacks, nightmares or memories
• intense anxiety
• intense agitation
• increased heart rate
• tremors
• sweating
• increased awareness of the environment (hypervigilence)
• avoidance of anything associated with the traumatic event.

PTSD is diagnosed when symptoms last more than one month. Simple PTSD accurately describes the symptoms that can result when a person experiences a one-time event such as a car accident or a natural disaster.

Complex posttraumatic stress disorder

Clinicians and researchers have found that the current DSM-IV PTSD diagnosis often does not capture the severe psychological harm that occurs when the traumatic experience continues for a long time. For example, ordinary, healthy people who experience chronic trauma can experience changes in the way they see themselves and in the way they adapt to stressful events. Dr. Judith Herman suggests that a new diagnosis, called “complex PTSD” (sometimes called “disorder of extreme stress”), is needed to describe the symptoms of long-term trauma.

Experiences that can lead to complex PTSD include:

• long-term domestic violence
• long-term, severe physical abuse
• child sexual abuse
• internment in a concentration or prisoner of war camp.

The first requirement for the complex PTSD diagnosis is that the person experienced a prolonged period in a situation in which he or she felt helpless or trapped.

Symptoms include alterations in:

• emotional regulation (e.g., persistent sadness, suicidal thoughts, explosive anger or inhibited anger)
• consciousness (e.g., forgetting traumatic events, reliving traumatic events or having episodes in which one feels detached from one's mental processes or physical body)
• self-perception (e.g., a sense of helplessness, shame, guilt, stigma and a sense of being completely different than other human beings)
• the perception of the perpetrator (e.g., attributing total power to the perpetrator or becoming preoccupied with the relationship to the perpetrator, including a preoccupation with revenge)
• relations with others (e.g., isolation, distrust or a repeated search for a rescuer)
• one's system of meanings (e.g., a loss of sustaining faith or a sense of hopelessness and despair).

Survivors may avoid thinking and talking about trauma-related topics because the feelings associated with the trauma are often overwhelming. Survivors (anywhere from 50 to 90 per cent) may use alcohol and other substances as a way to avoid and numb feelings and thoughts related to the trauma. Survivors may also engage in self-mutilation and other forms of self-harm.

Crises that threaten the safety of the person with PTSD (e.g., talking about suicide) or the safety of others (e.g., reacting violently when they feel threatened), must be addressed first. However, the best treatment results are achieved when both PTSD and the other disorder(s) are treated together rather than one after the other. This is especially true for PTSD and alcohol and other substance use.

Generalized anxiety disorder

People who have experienced at least six months of ongoing and excessive anxiety and tension may have generalized anxiety disorder. They usually expect the worst and worry about things, even when there is no sign of problems. They often experience the following symptoms:

• insomnia
• fatigue
• trembling
• muscle tension
• headaches
• irritability
• hot flashes.

Panic disorder

Panic disorder occurs when people have repeated panic attacks, the sudden onset of intense fear or terror. During these attacks, people may experience physical symptoms such as:

• shortness of breath
• heart palpitations
• chest pain or discomfort
• choking or smothering sensations
• fear of losing control
• fear of going crazy.

Many people with panic disorder develop anxieties about places or situations in which they fear another attack, or where they might not be able to get help. Eventually this can develop into agoraphobia, a fear of going into open or public spaces. Women are twice as likely as men to develop panic disorder, which usually begins in young adulthood.

Social phobia

People with social phobia experience a significant amount of anxiety and self-consciousness in everyday social situations. They worry about being judged by others and embarrassed by their own actions. This anxiety can lead them to avoid potentially humiliating situations. Other symptoms such as blushing, sweating, trembling, problems talking or nausea can also occur. Women are twice as likely as men to develop social phobia, which typically begins in childhood and early adolescence.

Obsessive-compulsive disorder

People with this condition have obsessive, unwanted thoughts that cause marked anxiety or distress and/or compulsions to behave in certain ways to manage the anxiety. They may perform rituals to prevent or make the obsessive thoughts go away (e.g., excessive hand washing or cleaning to prevent or diminish their fear of germs). These behaviours bring only temporary relief. If they are not treated, these obsessions and compulsions can take over a person's life.