Anxiety and Stress

Anxiety disorders include:

1. Generalized Anxiety Disorder (GAD)– This is characterized by an insidious onset in the third decade and a stable, usually chronic course which may or may not be punctuated by repeated panic attacks (episodes of acute anxiety). The symptoms of anxiety should last for at least a period of 6 months for a diagnosis of generalized anxiety disorder to be made. It is the commonest psychiatric disorder in the population

2. Panic Disorder – This is characterised by discrete episodes of acute anxiety. The onset is usually in early third decade with often a chronic course. The panic attacks occur recurrently every few days. There may or may not be an underlying generalised anxiety disorder. The episode is usually sudden in onset, lasts for a few minutes and is characterised by very severe anxiety. Classically the symptoms begin unexpectedly or ‘out-of-the-blue’. Panic disorder is usually seen about 2-3 times more often in females. Panic disorder can present either alone or with agoraphobia.

3. Phobic Disorders – Phobia is defined as an irrational fear of a specific object, situation or activity, often leading to persistent avoidance of the feared object, situation or activity. The common types of phobias are: 1. Agoraphobia, 2. Social phobia, and 3. Specific ( Simple) phobia.

  • Agoraphobia Agoraphobia is an example of irrational fear of situations. It is characterised by an irrational fear of being in places away from the familiar setting of home.
  • Social Phobia: It is characterized by an irrational fear of performing activities in the presence of other people or interacting with others.
  • Specific (Simple) Phobia: In contrast to agoraphobia and social phobia where the stimuli are generalized, in specific phobia the stimulus is usually well circum scribed. This is an example of irrational fear of objects or situations. Specific phobia is characterized by an irrational fear of a specified object or situation. Anticipatory anxiety leads to persistent avoidant behavior, while confrontation with the avoided object or situation leads to panic attacks. Gradually, the phobia usually spreads to other objects and situations.

4. Obsessive Compulsive Disorder (OCD)– The essential feature of this disorder is recurrent obsessional thoughts or compulsive acts. Obsessional thoughts are ideas, images or impulses that enter the individual’s mind again and again in a stereotyped form. They are almost invariably
distressing and the sufferer often tries, unsuccessfully, to resist them. An obsession is defined as:

  1. An idea, impulse or image which intrudes into the conscious awareness repeatedly.
  2. It is recognized as one’s own idea, impulse or image but is perceived as ego-alien (foreign to one’s personality).
  3. It is recognized as irrational and absurd (insight is present).
  4. Patient tries to resist against it but is unable to.
  5. Failure to resist, leads to marked distress.
  6. Acute and post traumatic stress disorders

STRESS is part of our life; it is impossible to remove all stress from our everyday lives. Some stress prepares us to meet certain challenges. Thus, some stress is productive (and therefore is essential) whereas some other stress is harmful. In this regards, the term EUTRESS is sometimes used to distinguish productive stress and the term DISTRESS is used to refer to harmful stress. Each person has a personal threshold of vulnerability, and an innate ability to tolerance stress. The external events may not be sufficient to cause mental disorder. Rather a combination of genetic and external factors has to exist for illness to occur.

Acute Stress Reaction

A transient disorder of significant severity which develops in an individual without any other apparent mental disorder in response to exceptional physical and/or mental stress and which usually subsides within hours or days. The stressor may be an overwhelming traumatic experience involving serious threat to the security or physical integrity of the individual or of a loved person(s) (e.g. natural catastrophe, accident, battle, criminal assault, rape), or an unusually sudden and threatening change in the social position and/or network of the individual, such as multiple bereavement or domestic fire. The risk of this disorder developing is increased if physical exhaustion or organic factors (e.g. in the elderly) are also present.

Post-Traumatic Stress Disorder ( PTSD )

This arises as a delayed and/or protracted response to a stressful event or situation (either short- or long-lasting) of an exceptionally threatening or catastrophic nature, which is likely to cause pervasive distress in almost anyone. Predisposing factors such as personality or previous history of neurotic illness may lower the threshold for the development of the syndrome or aggravate its course, but they are neither necessary nor sufficient to explain its occurrence.

Adjustment Disorders

States of subjective distress and emotional disturbance, usually interfering with social functioning and performance, and arising in the period of adaptation to a significant life change or to the consequences of a stressful life event (including the presence or possibility of serious physical illness). The stressor may have affected the integrity of an individual’s social network (through bereavement or separation experiences) or the wider system of social supports and values (migration or refugee status). The stressor may involve only the individual or also his or her group or community.