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Anxiety Disorders

What are the different types of anxiety disorders and how to recognise them?

Définitions
Who are the people most affected?
Diagnostic and treatement

Définitions

Anxiety disorders are diverse and cover various realities that should be clarified :

Anxiety: a mental state of trouble and agitation, a feeling of insecurity or fear without an object.

Anguish: it covers anxiety and its somatic signs of oppression and constriction. Anguish is a phenomenon of increasing intensity. Anxiety leads to anxiety, to which somatic signs are added.

Fear: is an anxious state accompanying the awareness of actual danger or threat, which is real and can be perceived by anyone.

Phobia: Phobia is a specific irrational fear triggered by an object or situation that is not inherently of a particularly dangerous in its nature. Fear disappears outside the object or the phobogenic situation. The danger is generally imaginary, related to the personality and history of the individual.

Stress: Stress is a reaction of non-specific adaptation of the body to a physical, psychological or social aggression. It is accompanied by an anxiety state.

These anxiety disorders can have important consequences on the emotional, professional and social life of the impacted individuals. Despite the difficulties they cause in everyday life, it is possible to recover from these disorders

General Anxiety Disorders

General Anxiety Disorders (GAD) is a state of permanent anxiety and excessive worry, which is maintained for at least six months. This anxiety is not related to a specific object or situation. It can be described as an excessive and permanent worry over everyday life (professional, family, emotional, social matters) that the person has trouble controlling.

GAD general symptoms are :

motor fatigue: fatigue, muscle tension, agitation, overexcitement ;

Hypervigilance: struggle to focus, trouble sleeping, irritability

Associated disorders: cold and wet hands, dry mouth, sweating, nausea or diarrhoea, frequent urination, difficulty in swallowing or feeling of a lump in the throat, tremor, contractions, pain, muscle soreness, irritable bowel syndrome, headache

Generalized anxiety can thus have a strong impact on daily life and be accompanied by a depressive state.

Panic attack

The panic attack is characterized by the abrupt and sudden feeling of death or imminent disaster which leads to a loss of self-control. This intense fear appears under circumstances without any vital risk for the person.

It is accompanied by physical and behavioural symptoms:

palpitations, heartbeat or rapid heartbeat, sweating, tremors or muscle twitches;

feeling of “breathlessness” or feeling of choking, feeling of strangulation, chest pain or discomfort, nausea or abdominal discomfort;

feeling dizzy, unstable, empty-headed, or feeling faint

derealization (feelings of unreality) or depersonalization (feeling detached from oneself);

afraid of losing control of oneself or going crazy, fear of dying;

feelings of numbness or tingling, chills or hot flush.

A panic attack lasts about 30 minutes and evolves according to the original cause and the context. These seizures can be spontaneous, reactive to a trauma or drug ingestion. They can also come with a specific organic disease, or occur in a particular psychopathological state such as depression, psychosis, or dementia.

Panic Disorder

Panic disorder: a repetition of panic attacks, spontaneous and unexpected coming with a fear of being afraid.

The panic disorder occurs between the ages of 20 and 30, most often in women. Its evolution alternates between remissions and aggravation phases. It can be complicated by phobias such as agoraphobia, but also by depression, or drug and alcohol abuses. The repercussions on the social and professional life can be important for the people concerned.

Phobias

Phobias: they are irrational fears, intense and specific to an object or a situation. Phobias are very common in normal psychic life. Phobias are considered as pathological depending on their intensity and their impact on the life of the patient.

People with phobias seek to avoid the object or situation that is causing their fear. They also develop behaviours to reassure them (called contraphobic behaviours). These people are generally aware of the absurd nature of their fear and suffer from it.

Here are the types of phobias we observe:

Specific phobias: patients feel an irrational and intense fear of animals (mouse, spider), objects (knives, scissors, feathers, blood), heights (empty), transportation (plane, train, car), closed places (claustrophobia), water, dark etc …

Agoraphobia: an irrational and intense fear of open spaces and crowded places, or any situation from which one can not escape easily (being alone away from home, being on a bridge …). These situations are experienced with great suffering or are avoided. As with other anxiety disorders, the impact on everyday life can be significant.

Social phobias: irrational and intense fear of situations where one is exposed to the eyes of others (fear of blushing, shaking, talking, eating…). Social phobia can also be a concern for an imaginary defect in one’s physical appearance: it is called dysmorphophobia. If a physical defect is apparent, the concern is obviously disproportionate. The patient may spend a lot of time looking at its “defect” or “healing”. He will try to reduce her anxiety but the effect is often the opposite. This sometimes leads patients to avoid seeing themselves (and to remove all mirrors in their environment).

Obsessive-compulsive disorder

Obsessive-compulsive disorders manifest as disturbing, repetitive and uncontrollable thoughts, called obsessions, that cause high anxiety. To reduce the resulting suffering, people develop repetitive, ritualized, irrational and irrepressible behaviours called compulsions.

Ideative obsession

We speak of ideative obsession when the patient’ mind is permanently, uncontrollably invaded by an idea or a thought, leading him to be exhausted by the struggle to neutralize it.

These are usually concrete ideas (words, numbers, objects, or people). It may also be more abstract ideas (a reference to morality, metaphysics, life, death, religion, order or sexuality), or ideas about behaviour. The person is prey to doubts, rumination, scruples. These ideas are accompanied by compulsions or rituals.

Phobic obsessions

Although close to phobia, phobic obsessions are different because they appear outside a phobogenic situation. It is not the situation that causes anxiety but the thought of it in particular.

Are generally observed :

phobias of diseases like cancer …

phobias of microbes and dirt …

impulse phobias (fear of committing an absurd, immoral act, of attacking someone or oneself). This remains mostly at the level of thought, intention, and acting out is exceptional.

Compulsion often accompanies obsessions and complicate them. It can be a compulsion to count, word sequences, or rituals of checking, washing, washing, dressing and undressing, bedtime etc.… They have a magical and conjuring character and are uncontrollable, and repetitively executed by the patient.

Who are the people most affected?

Generally, the demands for unbearable anxiety is caused by a stress overload. The patient worrying subjects are often real (family, professional or personal issues) and trigger a latent anxiety disorder.

Affected individuals generally have a predisposition to stress, and have a more sensitive, emotional and worry-prone personality. They usually have more frequent anxiety than average

Age can also be a triggering factor. Generalized anxiety disorders are expressed especially around 40-45 years old. With age, concern for the future as well as fatigue and stress are usually greater.

Gender can also be a factor to consider. Women, for social and educational reasons, are generally more prone to these disorders. Boys education tends to suppress the expression of emotions, while girls generally have more opportunities to express theirs. Growing up, men tend to channel their emotivity by other means (such as a more common alcoholic habit), while women tend to develop more anxiety or phobia problems.

Diagnostic and treatement

Diagnosis of anxiety disorders

Before diagnosing anxiety disorders, the possibility of somatic illness should be eliminated. But facing somatic symptomatology, one must also know how to identify an anxiety disorder.

We can distinguish anxiety and depression, even if these two states often coexist. To be more precise, we could say that depression is a mood disorder (sadness, inhibition, withdrawal, depreciation, suicide ideas), which often comes with anxiety.

Likewise, anxious and phobic states may be associated with depression, but may also result from abuse of psychotropic drugs and alcohol (often used to combat anxiety). Finally, some anxious and phobic states are also present in people suffering from delusions.

Treatment of anxiety disorders

Depending on the situation, the treatment of anxiety disorders may include lifestyle advice, relaxation, psychotherapy and/or medication:

Lifestyle

Decreasing coffee consumption, quitting alcohol and tobacco use, and regular physical activity (walking, running, swimming or cycling) are recommended.

Relaxation

Relaxation improves emotional control, helps to disconnect from the environment and to focus on oneself and avoids the accumulation of muscular and psychological tensions.
Relaxation may be associated with behavioural therapy

Psychotherapies

It is a treatment by psychological means, which is done through regular interviews, individually or in groups, with a psychotherapist.

The duration of treatment varies from a few months to a few years. It can be practised alone or in combination with other therapeutics (e.g. psychotropic drugs). All problems of anxiety type can benefit, whatever the psychic suffering expressed.

cognitive-behavioural Therapies (CBT)

Short, scientifically validated therapies designed to replace negative ideas and maladaptive behaviours with thoughts and reactions that reflect reality.

Generally 10 to 25 sessions, individually or in a group, during 30 to 45 minutes.

Psychoanalysis

Psychoanalysis makes it possible to return to the conscious level of repressed memories, in order to unravel the unconscious conflicts at the origin of the troubles.

This accompaniment lasts several years, with several sessions of 30 to 45 minutes per week.

Psychoanalytic psychotherapy

It helps to decrease or disappear the symptoms and promotes the appearance of a better adaptation.

These are short therapies (3 to 6 months), in response to reaction problems. More extended therapies (2 or 3 years) are recommended when it comes to regaining self-confidence and strengthening the person’s abilities.

Group psychotherapy

It promotes the expression of feelings and emotions related to anxiety disorders in order to increase the freedom of the person. They can operate via several methods (psychodrama, groups of words …).

This type of therapy lasts 1 or 2 years, with weekly sessions of 1 to 2 hours.

Medication

The goal of treatment with psychotropic medication is to relieve the suffering of the person and reduce mental disorders, in order to have the best life possible.

The doctor, psychiatrist or generalist, after having identified the symptoms of a psychic disorder, can prescribe, if necessary, a psychotropic treatment. He then offers psychological and medical support during the treatment period.

Anxiolytics (or tranquillizers) are generally used to relieve anxiety disorders, but also sleep disorders. Anxiolytics usually used are mainly benzodiazepines. Some antidepressants, antihistamines, beta-blockers and some neuroleptics are also used to relieve anxiety disorders.