CHAPTER 8 Anxiety and post-traumatic disorders
Anxiety is, of course, a perfectly normal phenomenon. Indeed, without any anxiety we would be comatose or dead! To perform optimally in any given situation, we do need a certain amount of anxiety/arousal. Sometimes, it is appropriate for us to have a massive surge of anxiety, such as when we are confronted by a life-threatening situation: the so-called ‘fight or flight’ response. However, if one experiences too much anxiety most of the time and/or in excess to the level of ‘threat’, it can become incapacitating and un-useful. The Yerkes-Dodson curve (Fig 8.1) demonstrates this.
The precise point at which anxiety becomes so severe as to constitute a ‘disorder’ is open to conjecture, and needs to be assessed on an individual basis. The general rubric that the anxiety response is excessive/prolonged, causes the individual distress and impairs their psychosocial functioning is a useful enough starting point. Note, though, that some anxious people are so good at avoiding their feared situation that they might effectively avoid ever becoming anxious, yet be objectively impaired in terms of the restriction this places on their life. The current DSM–IVTR and ICD–10 classifications of the anxiety disorders are summarised in Table 8.1.
TABLE 8.1 Classification of anxiety disorders according to DSM–IVTR and ICD–10
| DSM–IVTR (synopsis) | ICD–10 (synopsis) |
|---|---|
| Panic disorder | Panic disorder |
| Agoraphobia without panic | Agoraphobia |
| Social anxiety disorder | Social phobia |
| Specific phobia | Specific phobia |
| Generalised anxiety disorder | Generalised anxiety disorder |
| Obsessive-compulsive disorder | Obsessive-compulsive disorder |
| Acute stress disorder | Acute stress reaction |
| Post-traumatic stress disorder | Post-traumatic stress disorder |
Anxiety symptoms can be seen as a manifestation of a number of physical and psychiatric disorders, and these need to be assessed and treated in their own right (see Box 8.1).
A panic attack is essentially a severe burst of anxiety, be it in response to a particular stimulus, or ‘out of the blue’. There are somatic and psychic/cognitive features, as shown in Box 8.2. By definition, the attack should reach a peak within 10 minutes, but in many cases it is very abrupt. Panic attacks resolve with time, and can be attenuated with slow-breathing techniques.
Panic disorder
Of themselves, panic attacks carry no diagnostic specificity, and many people have them during their lives. Sometimes, they are an indicator of an underlying physical problem, and these need to be investigated where appropriate (see Box 8.1).
