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Anxiety Disorders

Experience of anxiety: where does it come from? 

  • Genes & Environment

Anxiety Disorders

Trauma Related (PTSD) 

  • traumatic events disrupt a person’s homeostasis

Anxiety Disorders


  • principle by which our bodies function
  • drive to keep in balance
  • mechanisms to correct that which goes awry
  • when person experiences stress, homeostasis goes out and physical things will change
  • heart rate will accelerate, temperature will increase, glucose levels rise, etc. 
  •  Body seeks to re-stabilize and does so by secreting two hormones:
    • Epinephrine/adrenaline 
    • Gluco-cortical/Cortisol  

Anxiety Disorder

“Fight or flight” response engages these hormones in response to a traumatic event, or for anticipation of one.  

  • Epinephrine/adrenaline 

  • Gluco-cortical/Cortisol  

Anxiety Disorders

Anticipatory anxiety 

  • is most common of all anxiety and releases these hormones
    • (adrenaline and Cortisol) 
  • spilled into the brain without actual danger
  • (This is the biological basis of anxiety) 
  • this anxiety exists in anticipation of an event(s)
  • (i.e. anxiety over whether or not my car will start when I leave class even though nothing is wrong with my car at all)

Anxiety Disorders

Psychological experience of person in anxiety...

  • overestimate the danger; tense


What is the most common of all disorders we deal with? 

  • Anxiety



  • emotional response to real or perceived effects 



  • anticipation of future threats causing you vigilance, caution, hypertension, and the tendency to avoid places where the fear would be even worse
  • Runs in families like mood disorders 

  • Frequently misdiagnosed and/or ignored by physicians (especially in women) 


Panic Attacks

  • short periods of intense fear; last approx. 10 minutes



  • Up to 3% of the population have a lifetime anxiety 
  • It is the primary symptom of up to 25% of all psychiatric disorders 
  • Up to 70% of patients who visit physicians for treatment have anxiety and stress as significant factors (may go for other things but this is something that is going to be a problem)


Comorbid Conditions

  • Major depressive disorder (depression often co-occurs with anxiety)
  • Substance use disorder (often people attempt to self-medicate)
  • Hypertension (common; known as “elevated blood pressure”)



  • (don’t say “when it started” – use the term “onset”)
  • Often preceded by: 
  • Marital disruption 
  • Death, crisis 
  • Financial upheaval, etc. 


Why is anxiety often misdiagnosed? 

  • it can be overlooked and if you have an addictive behavior also that will be picked up first. 


 Statement to remember Generalized Anxiety diagnosis 

  • JJ has all the worries all the time


What is the difference btw fear and anxiety?

  • Fear happens when something is imminent or happening
  • anxiety is in anticipation of something 


Statement to remember Specific Phobia diagnosis

  • Jessica is afraid of the specific thing, spiders 


Statement to remember social anxiety diagnosis

  • Fear of being in front of people and getting judged 


Symptoms of Panic Attack

(Always present with panic disorder)

  • Palpitations or racing heart 
  • Sweating 
  • Trembling 
  • Shortness of breath or smothering sensation 
  • Choking sensation 
  • Chest pain or discomfort 
  • Abdominal discomfort 
  • Dizziness or fainting sensation 
  • Derealization
    • [feeling as though people and world around you are not real or move in slow motion]
  • depersonalization
    • [see self as outside of your own body; observing self] 
  • Fear of losing control or “going crazy” 
  • Fear of dying 
  • Numbness or tingling sensation
  • Chills or hot flashes 


Uncued Panic Attack 

  • nothing is causing panic attack
  • (comes from nowhere)


Cued (or expected) Panic Attack 

  • developing panic attack in presence of something
  • they are in response to something


Agoraphobia and sentence to remember the diagnosis 

  • the experience of anxiety in a specific situation from which you do not feel you can escape easily


What are the four types of Specific Phobia? 

  • Animal
  • natural environment
  • blood/injection/injury
  • situational 


Symptoms of Specific Phobia 

  • Excessive fear of specific object or situation 
  • Exposure to stimulus almost invariably causes anxiety 
  • Person recognizes anxiety is excessive 
    • could lead to client feeling excessive guilt, or others making that person feel guilty
  • Stimulus is avoided or endured with great anxiety 
  • Avoidance or the distress interferes in functioning 


What needs to be ruled out before diagnosing specific phobia?

  • OCD,
  • PTSD,
  • Panic Disorder,
  • Agoraphobia,
  • Social Phobia,
  • Separation Anxiety Disorder  


Treatment Planning considerations for Specific Phobia

  • Anti-depressants
  • Systematic Desensitization
  • Exposure to the object of the phobia or the situation


Symptoms of Social Phobia

  • Fear of social or performance situations (being evaluated or judged) in which person is exposed to either unfamiliar people or scrutiny of others
  • Exposure to social situation almost invariably causes anxiety 
  • Person recognizes fear is excessive 
  • Situations are either avoided or endured with great anxiety 
  • Avoidance or distress interferes in functioning 


What needs to be ruled out before diagnosing Social Phobia?

  • Medical condition or substance use,
  • Panic Disorder,
  • Agoraphobia,
  • Separation Anxiety Disorder,
  • Eating Disorder,
  • Body Dysmorphic Disorder 


What does JCAHO stand for and what does it do?


What do Common Clinic Commitees do?

  • Continuous quality improvement
  • utiliztiation review
  • safety
  • infection control
  • clinic privileges and credentialing