ANXIETY, TRAUMA-AND STRESSOR-RELATED
THE COMPLEXITY OF ANXIETY DISORDERS
ANXIETY, FEAR AND PANIC
Anxiety is a negative mood state characterized by
bodily symptoms of physical tension and by
apprehension about the future (American Psychiatric
Association, 2013; Barlow, 2002).
Fear is an immediate alarm reaction to danger. While
traditionally considered a “negative” emotion, fear
actually serves an important role in keeping us safe as
it mobilizes us to cope with potential danger.
Panic is a sudden overwhelming reaction
A panic attack is an abrupt experience of intense fear
or acute discomfort, accompanied by physical
symptoms that usually include heart palpitations,
chest pain, shortness of breath, and, possibly,
dizziness.
Two basic types of panic attacks are described in
DSM-5: expected and unexpected.
1. Expected attacks are more common in
specific phobias or social anxiety disorder.
2. Unexpected panic attacks occur suddenly
without any obvious cause or indication.
Causes of Anxiety Disorder
A. Biological Contribution
There is evidence shows that we, humans born with
tendency to be tense, uptight, and anxious (Barlow et
al., 2014; Clark, 2005; Eysenck, 1967; Gray &
McNaughton, 2003).
No single gene seems to cause anxiety or panic but
our genes may make us more open to anxiety which
can influence how our brains react to stress.
B. Psychological Contribution
"Sense of control"
Can makes us less vulnerable and have ability to deal
with the upcoming events.
“Sense of uncontrollability"
We may learn as children that events are not always
in our control (Chorpita & Barlow, 1998; Gallagher,
Bentley, & Barlow, 2014).
Interestingly, the actions of parents in early childhood
seem to do a lot to foster this sense of control or
uncontrollability (Barlow, Ellard et al., 2014; Bowlby,
1980; Chorpita & Barlow, 1998;, Hostinar, Sanches,
Tottenam, & Sullivan, 2015).
 Parents who provides a secure home while
letting their children to explore the world and
let them learn on how to control when it comes
to unexpected events which will help to develop
the sense of control.
 Parents who are overprotective and over
intrusive and who “clear the way” for their
children and never letting them experience any
hardships. In other hand, children never learn
how to cope with adversity when it comes
along.
C. Social Contribution
Stressful life events trigger our biological and
psychological vulnerabilities to anxiety. Most are
social and interpersonal in nature—marriage, divorce,
difficulties at work, death of a loved one, pressures to
excel in school, and so on. Some might be physical,
such as an injury or illness.
An Integrated Model
The triple vulnerabilities are combined factors that
increase risk for developing disorders.
1. The first vulnerability (or diathesis) is a
generalized biological vulnerability. Perhaps it
might genetically tendency to be uptight or
high-strung. Although, generalized biological
vulnerability is not enough to cause anxiety.
2. The second vulnerability is generalized
psychological vulnerability is based on early
experiences which influences on how we view
the world. If we grow up believing the world is
dangerous and out of control and you might not
be able to cope when things go wrong based on
your early experiences.
3. The third vulnerability is a specific psychological
vulnerability in which you learn from early
 experience, such as being taught by your
parents, that some situations or objects are
danger (even if they really aren’t).
Comorbidity is called as co-occurrence of two or more
disorders in a single individual.
Comorbidity of Anxiety and Related Disorders
The high rates of comorbidity among anxiety and
related disorders (and depression) emphasize how all
of these disorders share the common features of
anxiety and panic described here.
They also share the same vulnerabilities— biological
and psychological—to develop anxiety and panic.
Comorbidity with Physical Disorders
Anxiety disorders also co-occur with several physical
conditions (Kariuki-Nyuthe & Stein, 2015). Physical
conditions such as thyroid disease, respiratory
disease, gastrointestinal disease, arthritis, migraine
headaches, and allergic conditions (Sareen et al.,
2006).
Thus, people with these physical conditions are likely
to have an anxiety disorder but are not any more
likely to have another psychological disorder.
If someone has both an anxiety disorder and one of
the physical disorders mentioned earlier, that person
will suffer from greater disability and a poorer quality
of life from both the physical problem and the anxiety
problem than if that individual had just the physical
disorder alone (Belik, Sareen, & Stein, 2009; Comer et
al., 2011; Sareen et al., 2006).
SUICIDE
 Weissman and colleagues found that 20% of
patients with panic disorder had attempted
suicide, based on the epidemiological data.
 The Weissman study confirms that having any
anxiety disorder, not just panic disorder, uniquely
increases the chances of having thoughts about
suicide (suicidal ideation) or making suicidal
attempts (Sareen et al., 2006).
 The risk of someone with panic disorder
attempting suicide is comparable to that for
individuals with major depression (Johnson,
Weissman, & Klerman, 1990; Weissman, Klerman,
Markowitz, & Ouellette, 1989).
 Even if an individual has depression, which we
know is a big risk for suicide attempts, anxiety
disorders combined with depression will make the
risk of suicide significantly greater than the risk for
a person who has depression alone.
ANXIETY DISORDER
Anxiety disorders are a type of mental health
condition. Which is different from ordinary feelings of
anxiety or anxiousness, and include excessive fear or
uneasiness. Work performance, academics, and
interpersonal relationships will all be affected.
Types of Anxiety Disorder
1. Generalized Anxiety Disorder (GAD)
Generalized anxiety disorder (GAD) involves persistent
and excessive worry that interferes with daily
activities even when there is no reason to worry
about.
2. Panic Disorder
Panic disorder is characterized by panic attacks and
sudden feelings of terror sometimes striking
repeatedly and without warning.
When you are having a panic attack you may
experience:
 Shaking
 Sweating
 Rapid/pounding heart rate
 Chest pain
3. Phobia
A phobia is a type of anxiety disorder. It is a strong,
irrational fear of something that poses little of an
object or situation.
Specific phobia is or a simple phobia individuals who
suffer from intense fear or anxiety when exposed to
specific objects or situations. Some specific phobias
like fear of:
Environmental phobias - including deep water,
heights and germs
Animal phobias - including a fear of dogs, snakes or
spiders
Situational phobias - such as flying in an airplane or
visiting the dentist
Bodily phobias - including blood or having shots
4. Separation Anxiety Disorder
Separation anxiety disorder (SAD) is defined as
excessive worry and fear about being apart from
family members or individuals to whom a child is most
attached.
What causes anxiety disorder?
Anxiety disorders causes aren't yet clear to the
researchers but there are risk factors that mostly will
develop anxiety disorder such as life experiences like
as traumatic experiences in persons who are already
anxious and also inherited characteristics can also
play a role.
Symptoms and Treatments
These are the common anxiety signs and symptoms
include:
 Feeling nervous, restless or tense
 Having a sense of impending danger, panic or
doom
 Having an increased heart rate
 Breathing rapidly (hyperventilation)
 Sweating
 Trembling
 Feeling weak or tired
 Trouble concentrating or thinking about
anything other than the present worry
 Having trouble sleeping
 Experiencing gastrointestinal (GI) problems
 Having difficulty controlling worry
 Having the urge to avoid things that trigger
anxiety
Anxiety disorders are generally treated with
psychotherapy, medication, or both.
Psychotherapy or “talk therapy”.
Cognitive Behavioral Therapy (CBT) it teaches people
different ways of thinking, behaving, and reacting to
anxiety-producing and fearful objects and situations.
Medication does not cure anxiety disorders but can
help relieve symptoms.
Can anxiety disorders be prevented?
You can’t prevent anxiety disorders. But you can take
steps to control or reduce your symptoms:
Check out medications: Talk to a healthcare provider
or pharmacist before taking over-the-counter
medications or herbal remedies.
Limit caffeine: Stop or limit how much caffeine you
consume, including coffee, tea, cola and chocolate.
Live a healthy lifestyle: Exercise regularly and eat a
healthy, balanced diet.
Seek help: Get counseling and support if you
experienced a traumatic or disturbing event.
TRAUMA AND STRESSOR-RELATED DISORDERS
Set of disorders that all develop after a relatively
stressful life event, often an extremely stressful or
traumatic life event.
Includes:
 Attachment disorders in childhood following
inadequate or abusive child-rearing practices.
 Adjustment disorders characterized by
persistent anxiety and depression following a
stressful life event, and reactions to trauma
such as
✓posttraumatic stress disorder
✓and acute stress disorder
Posttraumatic Stress Disorder
Clinical Description
 DSM-5 describes the setting event for PTSD as
exposure to a traumatic event during which an
individual experiences or witnesses or threatened
death, actual or threatened serious injury, or
actual or threatened sexual violation.
 Victims re-experience the event through
memories and nightmares.
 Also, victims are having flashbacks when a
memories occur suddenly which accompanied by
strong emotion and the victims find themselves
reliving the event.
 DSM-5 added addition of “reckless or self-
destructive behavior” under the PTSD E criteria as
one sign of increased arousal and reactivity.
 Also "dissociative” added which is describing
victims who do not necessarily react with the re-
experiencing or hyperarousal, is characteristic of
PTSD.

Causes of PTSD include:

 serious accidents
 physical or sexual assault
 abuse, including childhood or domestic abuse
 exposure to traumatic events at work,
including remote exposure
 serious health problems, such as being
admitted to intensive care
 childbirth experiences, such as losing a baby
 war and conflict
 Torture