Anxiety Disorders

Over the years, the DSM has naturally changed. Homosexuality is no longer a disorder, for example. The number of described disorders has greatly increased, from 130 disorders in the original manual to 237 disorders in the current manual. Categories of diagnoses have also been changed over time. The downside of the DSM-5 is that it turns human conditions into pathologies so that many people will have some type of pathology according to the manual.

The International Classification of Diseases or the ICD is another classification manual developed by the World Health Organization or WHO. It was developed after World War II and has been revised. There are similarities and differences between the manual and the DSM-5. The current goal is to somehow coordinate the two manuals. The ICD is used more for clinical diagnosis, while the DSM is used more for research purposes.

ANXIETY DISORDERS

Anxiety is not the same thing as fear. Anxiety does not necessarily have an imminent threat, while fear has some time of obvious and imminent threat. Fear is an instant reaction, while anxiety tends to be pervasive. Both involve avoidance, apprehension, and cautiousness. Anxiety does not have to be a bad thing; it can be motivating and can precipitate changes in behavior. The person with an anxiety disorder has an experience that is disruptive to them, is persistent, and is out of proportion to the real threat. Anxiety disorders are common and are frequently comorbid with each other.

A type of anxiety disorder is specific phobia. This is the distressing and persistent fear of a certain thing, such as flying, the dentist, or certain animals. The person knows it is an irrational fear but they cannot help it. There is a great desire to avoid the source of the fear. In order to be a specific phobia, the symptoms need to disrupt the person s life. Certain types of therapy can be used to decrease the impact of the symptoms on the person s life.

Agoraphobia is a separately listed phobia, which involves having a fear of places where the person cannot find a way to escape. Panic disorder is also a different disorder. Phobias in general come out of learning theories, such as vicarious learning, classical

conditioning, and verbal transmission or getting information that leads to fear. Most people develop a phobia of things that are not actually dangerous to them.

Social anxiety disorder or social phobia involves extreme or persistent fears of social situations because of a fear of being judged negatively by others. It affects 12 percent of all people in the US at some point in life. The individual fears doing something embarrassing or humiliating; they fear saying or doing something that would lead to rejection. Public speaking and meeting with strangers are common associated fears, along with eating in public and using public bathrooms. The disorder is distressing and affects everyday life. Self-medication in order to avoid the feelings is very common.

Panic disorder comes on suddenly and unexpectedly. A common feature of panic disorder is the presence of extreme physical symptoms such that the person feels they are dying. Common symptoms include dizziness, shortness of breath, chest pain, palpitations, nausea, and abdominal distress. There can also be derealization, which is a dreamlike state, and depersonalization, which is the feeling of not being real. The symptoms must be recurrent and disruptive to the person s life. There can be predictable or unpredictable triggers. A panic attack alone does not meet the criteria for panic disorder.

Panic disorder is largely inherited but with unknown genes involved. It is believed to be related to a dysfunction of the locus coeruleus in the brain. This part of the brain secretes norepinephrine, which is linked to fear and anxiety. There is also classical conditioning involved in getting a panic attack. The person with the disorder may have an excessive response to certain bodily sensations compared to the average person. Normal bodily reactions are interpreted anxiously and catastrophically.

Generalized anxiety disorder involves a continual state of worry about many different things. The worry is uncontrollable and generalized to many different life situations. These people worry diffusely and have these symptoms for longer than six months, resulting in easy fatiguability, exhaustion, sleep problems, and muscle tension. It affects almost six percent of people and is twice as likely to be seen in women. There is an increased risk of other anxiety disorders, mood disorders, and heart disease. The disorder is modestly inherited and is believed to stem from childhood trauma.