ANXIETY DISORDERS
stores to glucose for food
Anxiety
• it is a response to external or internal
stimuli that can have behavioral,
emotional, cognitive, and physical
symptoms.
• is distinguished from fear, which is
feeling afraid or threatened by a clearly
identifiable external stimulus that
represents danger to the person.
Anxiety Disorders
• comprise a group of conditions that
share a key feature of excessive anxiety
with ensuing behavioral, emotional,
cognitive, and physiologic responses.
ANXIETY AS A RESPONSE TO STRESS
Stress
✔ Is your body’s way of responding to any
kind of demand or threat.
✔ It occurs when a person has difficulty
dealing with life situations, problems,
and goals. Each person handles stress
differently
• Hans Selye (1956, 1974), an
endocrinologist, identified the
physiologic aspects of stress, which he
labeled the general adaptation
syndrome.
• He determined three stages of reaction
to stress:
• In the alarm reaction stage, stress
stimulates the body to send messages
from the hypothalamus to the glands
and organs to prepare for potential
defense needs.
Gland - such as the adrenal gland, to send out
adrenaline and norepinephrine for fuel
Organs - such as the liver, to reconvert glycogen
• In the resistance stage, the digestive
system reduces function to shunt blood
to areas needed for defense.
• The lungs take in more air, and the heart
beats faster and harder so it can
circulate this highly oxygenated and
highly nourished blood to the muscles
to defend the body by fight, flight, or
freeze behaviors.
• But if the person adapts to the stress,
the body responses relax, and the
gland, organ, and systemic responses
abate.
• The exhaustion stage occurs when the
person has responded negatively to
anxiety and stress: body stores are
depleted or the emotional components
are not resolved, resulting in continual
arousal of the physiologic responses
and little reserve capacity.
What are the different theories on the cause of
anxiety?
Psychoanalytic Theory
Anxiety is caused by a conflict between the
Id and Super ego.
Interpersonal Theory
Cause of anxiety is fear of interpersonal
rejection.
Behavioral Theory
Anxiety is a product of frustration.
Learning Theory
Exposure to early life fearful experience
causes anxiety.
Conflict Theory
 Presence of two opposing drives, causes • More common in women than men
anxiety.
• Minority children and children from low
Biologic Theory socioeconomic environments at risk

Anxiety may accompany physical • A familial predisposition exists

ailments/disease.
How much is too much?
Family Studies
• When anxiety is out of proportion to
Anxiety can run in families the situation that is creating it.

Precipitating Factors • When anxiety interferes with social,

occupational, or other important areas
Threat to one’s biological integrity
of functioning.
e.g. surgery
Anxiety Disorders
Threat to one’s self system
• Agoraphobia with or without panic
e.g. insult disorder

Peplau’s 4 Levels of Anxiety • Panic disorder

• At the mild level, individuals employ • Specific phobia

various coping mechanism to deal with
• Social phobia
various stress.
• OCD
• Includes: eating, drinking, sleeping,
physical exercise, smoking, crying, • Generalized anxiety disorder (GAD)
laughing, and talking to persons with
• Acute stress disorder
whom they feel comfortable.
• Posttraumatic stress disorder.
• Anxiety at the moderate to severe level
that remains unresolved will result to a Agoraphobia
number of physiological disorders –
migraine headaches, cardiac Panic disorder
arrhythmias Specific phobia
• Extended periods of repressed severe Social phobia
anxiety can result to psychoneurotic
patterns of behaving – anxiety disorders Obsessive–compulsive disorder
and somatoform disorders Generalized anxiety disorder
Anxiolytic Drugs • is characterized by at least 6 months of
Anxiety provides the motivation for persistent and excessive worry and
achievement, a necessary force for survival. anxiety.

• Anxiety disorders are the most common • Apprehensive expectations more days
of all psychiatric illnesses than not for 6 months or more about
several events or activities;
 uncontrollable worrying; significant
distress or impaired social or
occupational functioning; three of the
following symptoms: restlessness, easily
fatigued, difficulty concentrating or
mind going blank, irritability, muscle
tension, sleep disturbance
• Intervention: anti-anxiety;
psychotherapy
Acute stress disorder
Post-Traumatic Stress Disorder (PTSD)
Post-Traumatic Stress Disorder
PTSD Symptoms are generally grouped into four
types intrusive memories; avoidance, negative
changes in thinking and mood; and changes in
physical and emotional reactions. Symptoms
can vary over time or vary from person to
person:
Symptoms of intrusive memories may include:
• intrusive recollections or dreams,
flashbacks, physical and psychological
distress over reminders of the event
Symptoms of avoidance may include:
• avoidance of thoughts, feelings,
conversations, people, places, amnesia,
diminished interest or participation in
life events, feeling detached or
estranged from others, restricted affect,
sense of foreboding
Symptoms of changes in physical and emotional
reactions (also called arousal symptoms) may
include:
• sleep disturbance, irritability or angry
outbursts, difficulty concentrating,
hypervigilance, exaggerated startle
response
Post-Traumatic stress disorder
Risk Factors
• a combination of factors including
genetic, environmental, psychological
and developmental.
• Anxiety disorders can run in families,
suggesting that a combination of genes
and environmental stresses can produce
the disorders.
• Shyness, or behavioral inhibition, in
childhood
• Having few economic resources
• Being divorced or widowed
• Exposure to stressful life events in
childhood and adulthood
• Anxiety disorders in close biological
relatives
• Parental history of mental disorders
• The CAUSE of anxiety disorders are
currently unknown but likely involve
• Researchers are finding that genetic and
environmental factors, frequently in
interaction with one another
Treatments and Therapies
• Anxiety disorders are generally treated
with psychotherapy, medication, or
both.
A. Psychotherapy or Talk Therapy
• must be directed at the person’s specific
anxieties and tailored to his or her
needs
Cognitive Behavioral Therapy (CBT)
• It teaches a person different ways of
thinking, behaving, and reacting to
anxiety-producing and fearful situations.
 • CBT can also help people learn and
practice social skills, which is vital for
treating social anxiety disorder.
Self-Help or Support Groups
• joining a self-help or support group and
sharing their problems and
achievements with others
• Internet chat rooms
• Talking with a trusted friend
Stress-Management Techniques
• Stress management techniques and
meditation can help
B. Medication
• See Table 13.3 DRUGS USED TO TREAT
ANXIETY DISORDERS
• Medication does not cure anxiety
disorders but often relieves symptoms.
- These are used as the initial treatment of an
anxiety disorder, or are used only if there is
insufficient response to a course of
psychotherapy.
❑ What are the priority NURSING
DIAGNOSES?
Ineffective individual coping
Anxiety
❑ What are the PRINCIPLES OF NURSING
CARE?
BE C →alm
A →dminister medications
L →isten to patient’s concern
M→inimize environmental stimuli