Anxiety Disorders

Anxiety is customarily present in PTSD.

However, there are times when anxiety symptoms are present in the absence of hallmark PTSD symptoms such as re-experiencing, avoidance, and/or reactive symptoms.

In these situations, the diagnosis may be:

• Generalized anxiety disorder, or
• Panic disorder

It’s treatable!

Remember, mental health conditions are treatable. See the Therapeutic Response section to learn more.

Generalized anxiety disorder

One of the most common anxiety diagnosis is generalized anxiety disorder. Features that help distinguish generalized anxiety disorder from nonpathological anxiety are that the worry associated with generalized anxiety disorder is excessive and typically interferes significantly with psychosocial functioning, is more pervasive, pronounced, and distressing, and typically is accompanied by physical symptoms. Generalized anxiety disorder consists of three main clusters of symptoms:

1. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance). This worry is disproportionate to actual or anticipated events.
2. The individual finds it difficult to control the worry.
3. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

• • Restlessness or feeling keyed up or on edge.
  • Being easily fatigued.
  • Difficulty concentrating or mind going blank.
  • Irritability.
  • Muscle tension.
  • Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

Development and course of symptoms

• Many individuals with generalized anxiety disorder report that they have felt anxious and nervous all of their lives.
• The median age at onset for generalized anxiety disorder is 30 years, later than that for other anxiety disorders.
• The symptoms of excessive worry and anxiety may occur early in life but are then manifested as an anxious temperament.
• The symptoms of generalized anxiety disorder tend to be chronic and can vary in intensity across the lifespan.
• Rates of full remission are very low.
• While clinical expression of generalized anxiety disorder is relatively consistent across the lifespan, the difference is in the content of the individual’s worry.
• The earlier in life individuals have symptoms that meet criteria for generalized anxiety disorder, the more comorbidity they tend to have and the more impaired they are likely to be.

Risk and prognostic factors

• Individual temperament – behavior inhibition, general negativity, avoidance of harm.
• Environment.
• Genetic predisposition.

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Panic disorder

Another anxiety diagnostic response to trauma events can be panic disorder. There are two main clusters of symptoms for this diagnosis.

1. Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes. Four (or more) of the following symptoms occur during that peak:
   • Palpitations, pounding heart, or accelerated heart rate.
   • Sweating.
   • Trembling or shaking.
   • Sensations of shortness of breath or smothering.
   • Feelings of choking.
   • Chest pain or discomfort.
   • Nausea or abdominal distress.
   • Feeling dizzy, unsteady, light-headed, or faint.
   • Chills or heat sensations.
   • Paresthesia (numbness or tingling sensations).
   • Derealization (feelings of unreality) or depersonalization (being detached from oneself).
   • Fear of losing control or “going crazy.”
   • Fear of dying.
2. Additional symptoms. At least one of the attacks has been followed by one month (or more) of one or both of the following:
   • Persistent concern or worry about additional panic attacks or their consequences (e.g., losing control, having a heart attack, “going crazy”).
   • A significant maladaptive change in behavior related to the attacks (e.g., behaviors designed to avoid having panic attacks).

Development and course of symptoms

• The median age at onset for panic disorder in the United States is 20-24 years. A small number of cases begin in childhood, and onset after age 45 years is unusual but can occur.
• The usual course, if the disorder is untreated, is often chronic but can be variable in symptom expression. Some individuals may have episodic outbreaks with years of remission in between, and others may have more continuous symptomatology.
• The course of panic disorder typically is complicated by a range of other disorders, in particular other anxiety disorders, depressive disorders, and substance use disorders.
• Typically, there is no difference in the clinical presentation between adolescents and adults. Lower prevalence of panic disorder in older adults appears to be attributable to age-related “dampening” of the autonomic nervous system response.

Risk and prognostic factors

• Individual temperament – anxiety sensitivity, general negativity, avoidance of harm.
• Environment – history of abuse, identifiable stressors.
• Smoking.
• Genetic predisposition.

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