Generalised Anxiety Disorder (GAD) and Panic Disorder/Agoraphobia

Generalised Anxiety Disorder (GAD) and Panic Disorder (PD)/Agoraphobia are both examples of anxiety disorders. These (often irrational) fears significantly interfere with normal life.

GAD is pervasive and sometimes progresses to more serious anxiety such as panic attacks. Anxious feelings are often associated with somatic complaints (stomach cramps, diarrhoea, rashes).

Panic Disorder is a more serious type of anxiety disorder. Panic attacks are usual and victims can misinterpret physical symptoms as heart attack. Fear leads to Agorapobia.

Here we consider the causes, maintenance and treatment of GAD and PD/Agoraphobia

Anxiety

Anxiety can be normal/healthy

Anxiety is apprehension towards an anticipated problem - as opposed to fear which is a reaction to threat

Anxiety can be disruptive when the problem is unfounded

Fear can be adaptive when it helps avoid danger

Anxiety Disorders

So when does normal anxiety become a disorder? When it interferes with normal functioning and is disabling

Anxiety disorders are part of 'affective disorders'

 - Depression

 - Also termed as neuroticism - neurotic - react to events with negative affect

Cognitive Features of Anxiety Disorders

 - Anxiety manifests in thoughts

 - Perception of impending disaster

 - Morbid preoccupation with uncertainty

 - Biased thoughts

 - Negative schemas

 - Self-fulfilling prophecy

Somatic Features of Anxiety Disorders

 - Shallow breathing

 - Dry mouth

 - Diarrhoea

 - Frequent/urgent urination

 - Faintness

 - High blood pressure

 - Rapid heart beat

 - Sweating

 - Muscle tension

GAD

Features

 - Excessive anxiety/worry

 - Variety of situations

 - Difficulty controlling

 - Interferes with focus on current activities

 - Associated with feeling tense, restless, easily fatigued, concentration problems, irritability, difficulty with sleep

Common Characteristics (Brown et al 2001)

 - Easily startled

 - Constantly on edge

 - Somatic complaints

 - Disturbed by worried feelings - individual doesn't know why they are worried which in turn makes them more worried

 - Often associated with more serious anxiety - panic attacks

 - Often 'comorbid' with depression or substance abuse

 - Worried about several 'minor' things (Tyrer and Baldwin, 2006) - job/college performance/relationships/health/death/being late - worries shift focus across the day

 - Live with perpetual anxious apprehension

 - Fear future events (without good cause)

 - over-emphasise lack of control over future events

GAD Aetiology (cause)

Psychodynamic (Freud)

 - Unconscious unresolved conflict between EGO and ID impulses

 - There is good and bad anxiety

 - Good = real danger/threat (realistic)

 - Bad = repeatedly prevented from expressing ID impulses resulting in pent up energy = anxiety (neurotic)

 - Bad = expression of ID impulses punished - associate impulses with punishment = anxiety (moral)

Cognitive (Mogg et al, 2004)

 - Focus on perceived threat (conscious or unconscious)

 - Biased assumptions - prepare for the worst

 - Believe that worrying may prevent bad events

 - Maladaptive problem solving/superstitions/hypervigilance

Biological

 - Reduction in serotonin (Mogg et al, 2004)#

 - Reduction in GABA which usually inhibits anxiety during stress

 - HPA axis dysfunction - usually controls reaction to stress

- Genetic factors (Hettema et al, 2001) - heritability has modest role with twins having 15-20% concordance rate

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