Types

The following are clinical variants of anxiety:

Generalised Anxiety Disorder

It is the most common form of anxiety disorder. Normal anxiety is clearly related to particular situations (such as starting a new job) but people with Generalised Anxiety Disorder worry excessively, often about matters that do not warrant any real reasons to worry, so much so that worrying becomes the primary attitude or response. Technically, the presence of any 3 or more of the following symptoms for 6 months (at least) would indicate Generalised Anxiety Disorder:

  • Restlessness
  • Irritability
  • Difficulty in concentration
  • Easy fatigability (easily tired)
  • Disturbed sleep
  • Muscle tension

Management includes use of anti-anxiety medications along with cognitive therapy, which focuses on altering thinking and behaviour patterns to reduce worry.

Panic Disorder

Panic is generally perceived as a severe and intense form of anxiety that may appear spontaneously or in response to some threat.

Panic attacks are distinct periods of intense but relatively short-lived (lasting not more than 10 minutes)  anxiety or fear, accompanied by symptoms such as palpitation, sweating, trembling, breathlessness, fear of losing control, etc.

Panic Disorders are repeated unexpected panic attacks followed by at least a month of the following:

  • Persistent concern about having more of such attacks (anticipatory anxiety),
  • Worry about implications of having an attack or change in behaviour related to attacks (e.g. avoiding individual or situations, known as avoidance) 
  • Significant distress to the affected individual in public places so much so that he avoids moving out in public (known as agoraphobia).
  • Increased vulnerability to depression, alcohol abuse, social and job-related dysfunction.
  • Association with heart disease (about 50% cases are known to have mitral valve prolapse) leads to functional impairment.

Management includes use of antidepressants or Benzodiazepines (valium or calmpose like medication) and cognitive behavioural therapy.

Phobia

Phobia is an excessive, irrational and morbid fear of  any object or situation which is apparently benign at that moment. The person constantly avoids the feared object or situation.

Certain common phobias are claustrophobia (fear of closed spaces), acrophobia (fear of height), criscaidocophobia  (fear of no.13).

Treatment is required when fear interferes with normal functioning of the individual. The person is gradually exposed to the feared object or situation until the threatening situation or object can be faced without fear (known as systemic desensitisation).

Post-traumatic stress disorder (PTSD)

Post traumatic stress disorder is a specific type of anxiety disorder that may develop in a person exposed to an extremely stressful traumatic event. Once the person experiences a traumatic event three different types of symptoms may develop :

  • Re-experiencing of the traumatic event in at least one of the following ways :
    • Repeated recall or dreams of the event
    • Flashbacks i.e. sudden sense of reliving the past experience. (e.g. as observed in some prisoners of wars)
    • Intense anxiety with any symbol that would remind them of the past traumatic event. (e.g. anniversaries)
  • Avoiding thinking or talking about the happening in the past (known as psychic numbing). The affected individual:
    • Avoids going to places or seeing people that reminds him of what happened.
    • Loses interest or stops participating in important activities.
    • Has difficulty experiencing strong emotions.
    • Is wary of his future (he/she might not have a proper career or might not get married etc)
  • Association with symptoms of increased arousal. The individual:
    • May have difficulty falling asleep (insomnia)
    • Might startle easily (exaggerated startle)
    • Is always watchful even if there’s no reason to be so (hypervigilance)

The person must re-experience at least 2 of the above mentioned symptoms to qualify for PTSD.

PTSD is confirmed if the individual experiences extreme agony and impaired (normal) social functioning due to persistence of these symptoms for a period of (at least) one month.

Management involves group therapy, medical treatment of depression and anxiety. Hypnosis has also been used in PTSD but its use is controversial.

Obsessive Compulsive Disorder (OCD)

Obsessive Compulsive Disorder is a severe psychiatric condition characterised by a pattern of senseless, repeated thoughts/feelings (Obsessions) and acts (Compulsions) that tend to go beyond control. The person is usually aware that these thoughts and actions are irrational, yet he is unable to stop or control them.

Obsession tends to increase anxiety but the moment the compulsive act is performed, the anxiety levels go down. Therefore if a person is unable to act as per his obsession, it tends to aggravate anxiety all the more.

  • Repeated acts of hand washing, checking and rechecking, praying excessively, counting and recounting are some of the common instances of compulsive acts.

Management includes behavioural therapy, antidepressant drugs (commonly fluoxetine), Chlomipramine. Resistant cases may respond to surgery (Cingulotomy).

Situational Adjustment Disorder

Situational adjustment disorder is defined as secondary to clearly identifiable anxiety and stress causing condition.